Serum prolidase, malondialdehyde and catalase levels for the evaluation of oxidative stress in patients with peripheral vertigo.

PURPOSE: We aimed to evaluate oxidative stress in patients with peripheral vertigo by measuring serum prolidase, malondialdehyde (MDA) and catalase levels. METHODS: A total of 30 patients (age: 60 <) with peripheral vertigo and 30 healthy subjects were recruited. Blood samples were collected from both groups and serum prolidase levels were measured using enzyme-linked immunosorbent assay (ELISA). MDA and catalase levels were measured by the spectrophotometric method. RESULTS: The most common cause of vertigo was BPPV (53.3%), followed by Ménière's disease (16.6%), vestibular neuritis (13.3%), lateral semicircular canal fistula (3.3%), and idiopathic vertigo (13.3%). Mean serum prolidase activity and MDA levels were significantly higher in the vertigo patients than in the control subjects (P < 0.05); however, there was no statistically significant difference in mean serum catalase levels between the groups (P > 0.05). CONCLUSION: We concluded that serum prolidase and MDA levels may be used as markers of oxidative stress in patients with peripheral vertigo.

Evaluation of the anatomical and auditory outcomes of minimally invasive cartilage myringoplasty: Our technique and experience.

The purpose of this study was to assess closure rates in tympanic membrane perforations of various dimensions using the tragal cartilage-perichondrium composite graft and its effect on hearing values and also to present our own experiences. MATERIALS AND METHODS: Sixty-one patients presenting to our clinic in 2014-2015 and diagnosed with tympanic membrane perforation were included in the study. Otomicroscopic and otoendoscopic examinations were performed preoperatively and at the 12th month postoperatively. Patients were divided into three groups depending on perforation diameter. Pure tone audiometry was performed at 500, 1000, 2000, and 4000Hz (Hz) preoperatively and at the 12th month postoperatively, air-bone values were recorded, and air-bone gap (ABG) was calculated. Surgery was performed under local anesthesia using the transcanal, push-through (transperforation) technique. Perichondrium supported by thinned cartilage graft obtained from the tragal cartilage was used for tympanic membrane repair. RESULTS: Graft acceptance levels after 12months in small, medium, and large perforations were 100%, 93.5%, and 93.75%, respectively, and 95% on average. Preoperative air-bone gap values were 18.64±9.63 decibel (dB), 22.51±9.66dB, and 28.43±11.36dB, respectively, and 23.18±11.36dB on average, while 12th month postoperative air-bone gap values were 9.14±8.27dB, 11.25±6.73dB, and 17.37±9.22dB, respectively, and 12.37±8.28dB on average. The difference between pre- and postoperative 12th month air-bone gap values was statistically significant (p<0.005). CONCLUSION: The use of thinned cartilage-supported perichondrial grafts in patients with all sizes of tympanic membrane perforation is safe and effective in terms of both anatomical healing and restoration of hearing and can represent a first-choice technique that is easy to perform and involves minimal morbidity.

Evaluation of nasal mucociliary activity in patients with chronic renal failure.

The ability of respiratory mucosal surfaces to eliminate foreign particles and pathogens and to keep mucosal surfaces moist and fresh depends on mucociliary activity. Chronic renal failure (CRF) is an irreversible medical condition that may result in important extrarenal systemic consequences, such as cardiovascular, metabolic, and respiratory system abnormalities. Although there are studies describing nasal manifestations of CRF, data are lacking concerning the effects of the condition on nasal mucosa. The goal of the current study was to evaluate nasal mucociliary clearance (NMC) time in patients with CRF. This prospective cohort study conducted in a tertiary referral center included 32 non-diabetic end-stage CRF patients and 30 control individuals. The control group consisted of voluntary participants who had been referred to our clinic for symptoms other than rhinological diseases. The mean NMC times in CRF patients and control individuals were 12.51 ± 3.74 min (range 7-22 min) and 8.97 ± 1.83 min (range 6-13 min), respectively. The mean NMC time in patients with CRF was significantly longer than that in control individuals (p < 0.001). Clinicians must keep in mind that NMC time in CRF patients is prolonged and must follow-up these patients more closely for sinonasal and middle ear infections.

Management of complications and compromised free flaps following major head and neck surgery.

Microvascular free flaps are preferred for most major head and neck reconstruction surgeries because of better functional outcomes, improved esthetics, and generally higher success rates. Numerous studies have investigated measures to prevent flap loss, but few have evaluated the optimal treatment for free flap complications. This study aimed to determine the complication rate after free flap reconstructions and discusses our management strategies. Medical records of 260 consecutive patients who underwent free flap reconstructions for head and neck defects between July 2006 and June 2010 were retrospectively reviewed for patient and surgical characteristics and postoperative complications. The results revealed that microvascular free flaps were extremely reliable, with a 3.5 % incidence of flap failure. There were 78 surgical site complications. The most common complication was neck wound infection, followed by dehiscence, vascular congestion, abscess, flap necrosis, hematoma, osteoradionecrosis, and brisk bleeding. Twenty patients with poor wound healing received hyperbaric oxygen therapy, which was ineffective in three patients who eventually experienced complete flap loss. Eleven patients with vascular congestion underwent medicinal leech therapy, which was effective. Among the 78 patients with complications, 44 required repeat surgery, which was performed for postoperative brisk bleeding in three. Eventually, ten patients experienced partial flap loss and nine experienced complete flap loss, with the latter requiring subsequent pectoralis major flap reconstruction. Microvascular free flap reconstruction represents an essential and reliable technique for head and neck defects and allows surgeons to perform radical resection with satisfactory functional results and acceptable complication rates.

How often parapharyngeal space is encountered in TORS oropharynx cancer resection.

Early stage oropharyngeal squamous cell carcinoma (OPSCC) may occasionally invade parapharyngeal space (PPS). Tumor invasion of PPS structures such as the carotid artery, internal jugular vein and cranial nerves IX-XII may add significant morbidity. We analyzed 73 patients who underwent transoral robotic surgery (TORS) for OPSCC between 2008 and 2012. Patients were selected based on preoperative evaluation including detailed physical and endoscopic examination, neck CT and/or PET-CT scan. T1, T2 and selected T3 cases were included in this study. None of the patients had obvious PPS extension on preoperative evaluation. All patients had OPSCC in palatine tonsil (60; 82.2 %) and base of tongue (13; 17.8 %). Twenty-seven patients had cT1 (37 %), 39 had cT2 (53.4 %), and 7 had cT3 (9.6 %) disease in clinical and radiologic evaluation. None of the oropharyngeal lesions had obvious radiologic PPS extension prior to operation. During TORS procedure, we encountered PPS in 18 (24.6 %) patients while resecting the deep margin. These parapharynx resections involved external carotid artery in 1, medial pterygoid muscle in 2, and parapharyngeal fat with or without styloid musculature in the remaining 15 patients. Except three cases, we were able to remove the lesions en bloc with negative surgical margins. TORS resection of oropharyngeal cancer extending to PPS appears to be a safe and feasible technique with minimal complications. Significant experience with TORS and further understanding of the endoscopic anatomy of PPS could obviate the morbidity associated with tumor resection in this dense neurovascular region.

Effects of Obstructive Sleep Apnea in Children as a Result of Adenoid and/or Adenotonsillar Hypertrophy on Maternal Psychologic Status.

The authors aimed to evaluate the effects of obstructive sleep apnea in children as a result of adenoid and/or adenotonsillar hypertrophy on maternal psychologic status. The study sample comprised the mothers of 66 children aged 3 to 15 years (mean age: 7.55 ±â€Š2.94 years) who were scheduled to undergo curette adenoidectomy or adenotonsillectomy because of airway obstruction. The mothers completed the 14-item Hospital Anxiety and Depression Scale (HADS), 20-item State-Trait Anxiety Inventory-1 (STAI-1), and 20-item State-Trait Anxiety Inventory-2 (STAI-2) questionnaires before the operation and 10 days afterwards. Mothers who were under psychiatric treatment or declined to fill the questionnaires were excluded from the study. The results obtained postoperatively by day 10, when all the children had considerable improvement in their breathing, were analyzed as control data. The mean postoperative HAD-A and HAD-D scores of the mothers were significantly lower than the mean preoperative scores (P < 0.001). Mothers' mean STAI-1 and STAI-2 scores were also significantly lower postoperatively (P < 0.001). Pediatric adenoidectomy or adenotonsillectomy to relieve airway obstruction has a beneficial effect not only on the health of pediatric patients but also on the psychologic status of their mothers.

Feasibility and clinical outcomes of transoral robotic surgery and transoral robot-assisted carbon dioxide laser for hypopharyngeal carcinoma.

Transoral robotic surgery (TORS) has been used as a novel procedure for squamous cell carcinoma of the laryngopharyngeal cancers with encouraging outcomes. The safety, feasibility, and efficacy regarding this approach have previously been demonstrated. There are several studies proposing the benefit of combining TORS with carbon dioxide (CO2) laser in resecting upper aerodigestive tract tumors. We report a series of patients with hypopharyngeal carcinoma treated with primary TORS with or without the flexible carbon dioxide (CO2) laser. All TORS resections were completed without any intraoperative complication. None required conversion to an open procedure. Clinical outcomes in this preliminary analysis indicate that magnified view, 3D visualization with the wristed instruments and tremor reduction technology of robotic experience, allow en bloc resection of early stage hypopharyngeal cancers. TORS with CO2 laser is a promising, minimally invasive surgical alternative for the treatment of hypopharyngeal tumors with comparable oncologic outcomes.

Neutrophil-to-lymphocyte ratio in patients with peripheral vertigo: a prospective controlled clinical study.

We aimed to investigate the relationship between peripheral vertigo and inflammation by using the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker. We recruited 103 patients with peripheral vertigo (71 women, 32 men; mean age, 39.8 ± 14.7 years) who presented to the Otolaryngology Department of Dumlupinar University Hospital. Vertigo patients with systemic diseases, neurological disorders, malignancy or any inflammatory disease that could alter the NLR were excluded from the study. We also enrolled 103 age- and sex-matched healthy subjects (controls; 82 women, 21 men; mean age, 36.7 ± 13.5 years) who underwent routine checkups in our hospital. The vertigo patients underwent full otolaryngologic and neurologic examinations and audiometric tests to rule out any other pathology causing the peripheral vertigo. NLR was calculated in all subjects and was compared between the patient and control groups. There were no significant differences between the study and control groups in terms of lipid profiles, liver-function tests, white blood cell (WBC) count, hemoglobin level, mean platelet volume, and vitamin B12 and folate levels. The mean NLR was significantly higher in the patients than in the controls (P<0.05). In conclusion, this study, which was the first to investigate the relationship between the NLR and peripheral vertigo, found that the NLR is significantly higher among peripheral vertigo patients than among healthy controls. This result suggests that the NLR is a novel potential marker of stress in peripheral vertigo patients.

Mean platelet volume levels in children with adenoid hypertrophy.

Adenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.

Histopathological analysis of tonsillectomy specimens: a report from Southeastern Anatolia.

OBJECTIVES: This study aims to evaluate the necessity of routine histopathological analyses of tonsillectomy specimens. PATIENTS AND METHODS: A retrospective review for 2,004 patients (1,048 males, 956 females; mean age 12.2 years; range 2 to 60 years) who underwent tonsillectomy between January 2009 and May 2013 was carried out at the Diyarbakir Training and Research Hospital, Turkey. Tonsillectomy specimens were fixed with formalin, and stained with hematoxylin and eosin before being sectioned and examined via light microscope. Chronic inflammation and lymphoid hyperplasia were considered non-significant pathological findings. Other pathological diagnoses including infectious processes, and benign and malignant neoplasms were regarded as significant pathological findings. RESULTS: Non-significant pathological findings -chronic inflammation, lymphoid hyperplasia or both- were observed in 1,972 patients. Significant pathological findings -epidermal cyst, mucocele, squamous papilloma, granuloma and squamous cell carcinoma- were observed in 32 patients. One patient was diagnosed with squamous cell carcinoma, and another had granulomatous disease diagnosed as tuberculosis. CONCLUSION: Histopathological examination is only necessary for patients with preoperative risk factors. Gross examination may be a good alternative since it is cost effective and not time consuming.

The role of thiamine pyrophosphate in prevention of cisplatin ototoxicity in an animal model.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of thiamine pyrophosphate against cisplatin-induced ototoxicity in guinea pigs. MATERIALS AND METHODS: Healthy guinea pigs (n = 18) were randomly divided into three groups. Group 1 (n = 6) received an intraperitoneal injection of saline solution and cisplatin for 7 days, group 2 (n = 6) received an intraperitoneal injection of thiamine pyrophosphate and cisplatin for 7 days, and group 3 (n = 6) received only intraperitoneal injection of saline for 7 days. The animals in all groups were sacrificed under anesthesia, and their cochleas were harvested for morphological and biochemical observations. RESULTS: In group 1, receiving only cisplatin, cochlear glutathione concentrations, superoxide dismutase, and glutathione peroxidase activities significantly decreased (P < 0.05) and malondialdehyde concentrations significantly increased (P < 0.05) compared to the control group. In group 2, receiving thiamine pyrophosphate and cisplatin, the concentrations of enzymes were near those of the control group. Microscopic examination showed that outer hair cells, spiral ganglion cells, and stria vascularis were preserved in group 2. CONCLUSION: Systemic administration of thiamine pyrophosphate yielded statistically significant protection to the cochlea of guinea pigs from cisplatin toxicity. Further experimental animal studies are essential to determine the appropriate indications of thiamine pyrophosphate before clinical use.

Extended high frequency audiometry in polycystic ovary syndrome.

OBJECTIVE: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder affecting 5-10% of women in reproductive age. Insulin resistance, dyslipidemia, glucose intolerance, hypertension, and obesity are metabolic disorders accompanying the syndrome. PCOS is a chronic proinflammatory state and the disease is associated with endothelial dysfunction. In diseases with endothelial damage, hearing in high frequencies are mostly effected in early stages. We evaluated extended high frequency hearing loss in PCOS patients. MATERIAL METHODS: Forty women diagnosed as PCOS and 25 healthy controls were included in this study. Age and BMI of PCOS and control groups were comparable. Each subject was tested with low (250-2000 Hz), high (4000-8000 Hz), and extended high frequency audiometry (8000-20000). Hormonal and biochemical values including LH, LH/FSH, testosterone, fasting glucose, fasting insulin, HOMA-I, and CRP were calculated. RESULTS: PCOS patients showed high levels of LH, LH/FSH, testosterone, fasting insulin, glucose, HOMA-I, and CRP levels. The hearing thresholds of the groups were similar at frequencies of 250, 500, 1000, 2000, and 4000 Hz; statistically significant difference was observed in 8000-14000 Hz in PCOS group compared to control group. CONCLUSION: PCOS patients have hearing impairment especially in extended high frequencies. Further studies are needed to help elucidate the mechanism behind hearing impairment in association with PCOS.

The clinical value of temporal bone tomography in chronic otitis media.

OBJECTIVES: This study aims to investigate the indications, the results and the limits of preoperative computed tomography (CT) scanning in chronic otitis media (COM), and to evaluate the clinical contribution of CT in determining the nature and complications of the disease. PATIENTS AND METHODS: In this cross-sectional study, the results of preoperative CT with operative findings during mastoidectomy in 50 patients with COM (28 males, 22 females; mean age 34 years; range 16 to 69 years) between January 2008 and January 2010 were analyzed. RESULTS: Computed tomography was highly sensitive to the presence of soft tissue, mastoid pneumatization, dural height, and temporal bone destruction with nearly 100% sensitivity. Its contribution to detecting lateral canal fistulas, facial canal dehiscence, tegmen tympani erosion, and ossicular integrity was limited. CONCLUSION: Preoperative assessment of COM with CT produce important guidance to evaluate the extent of the disease and to prevent possible intraoperative complications.

[Newborn hearing screening results at Zeynep Kamil Women and Children Diseases Education and Research Hospital]. / Zeynep Kamil Kadin ve Çocuk Hastaliklari Egitim ve Arastirma Hastanesi yenidogan isitme tarama bulgulari

OBJECTIVES: In this study, we aimed to present newborn hearing screening results performed at Zeynep Kamil Women and Children Diseases Education and Research Hospital, a reference hospital, within the past one year in the light of literature review. PATIENTS AND METHODS: Between January 1, 2010 and December 31, 2010, a total of 11.053 babies who were born in our hospital or referred to our hospital from other health care centers were included. All babies who were born in our hospital underwent transient evoked otoacustic emission (TEOAE) test within 10 days after birth. In addition, the babies younger than six months only who were referred to our hospital underwent the screening test. A detailed otological examination was performed on the babies who failed to pass the test and then hearing screening was done by automated auditory brainstem response (ABR) device (Bio-logic). Also, otoacustic emission and ABR tests were performed together on the babies who were considered at high risk for permanent congenital hearing loss. RESULTS: Of a total of 11.053 babies who underwent hearing screening, 8.490 (76.9%) passed the initial test. The results of stepwise test including three steps revealed that hearing loss was present in 17 babies (0.15%). CONCLUSION: Newborn hearing loss is the leading factor which impairs the speech and language development, if not diagnosed earlier. Hearing screening tests should be expanded throughout the country as soon as possible and the babies with hearing loss should be identified before permanent damages occur. As a result, these babies can be saved from being disabled and they can be raised as self-sufficient individuals who can contribute to the society.

Effects of ozone therapy on facial nerve regeneration.

INTRODUCTION: Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration. OBJECTIVE: We aimed to evaluate the effect of ozone therapy on facial nerve regeneration. METHODS: Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy. RESULTS: Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups. CONCLUSION: We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats.

Transoral Surgical Anatomy and Clinical Considerations of Lateral Oropharyngeal Wall, Parapharyngeal Space, and Tongue Base.

OBJECTIVE: With the emergence of transoral robotic approaches, head and neck surgeons are faced with an unfamiliar inside-out head and neck anatomy. This study was performed to describe key anatomic landmarks and surgical considerations of transoral robotic resection of the lateral oropharyngeal wall, the parapharyngeal space, and the base of the tongue. STUDY DESIGN: Descriptive transoral anatomic study. SETTING: Academic anatomy laboratory and tertiary academic hospital. SUBJECTS AND METHODS: Transoral dissections of the lateral pharyngeal wall, base of tongue, and parapharyngeal space were performed in 5 vascular silicone-injected cadavers to illustrate anatomic landmarks from the inside-out perspective. Lateral neck dissections were also performed to better appreciate the anatomic structures and to be more familiar with intraoperative anatomy. RESULTS: The neurovascular and muscular structures located in parapharyngeal space, lateral oropharyngeal wall, and base of tongue were described. Surgical significance of key anatomic landmarks was emphasized with high-quality illustrations. CONCLUSION: A thorough understanding of transoral anatomy is crucial to perform transoral robotic surgery safely and efficiently. To understand inside-out anatomy of base of tongue, lateral oropharyngeal wall, and parapharyngeal space, cadaveric dissection is highly beneficial and may help to shorten the learning curve for transoral robotic dissections.

Alterations in nasal mucociliary activity in polycystic ovary syndrome.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. It can affect various organ systems, and respiratory mucosa has been reported as being hormone responsive. STUDY DESIGN: A case-control study consisting of 50 women with PCOS and 30 control subjects matched for age and body mass index was conducted, in order to investigate nasal mucociliary clearance time (NMCT) in patients with PCOS. Serum basal hormonal-biochemical parameters and NMCT were evaluated on menstrual cycle days 2-5 for all participants. RESULTS: The mean NMCT in PCOS and control groups was 10.45±2.88 and 6.92±1.78, respectively (p=0.0001). A significant positive correlation was found between NMCT and duration of disease (r=0.52; p=0.001), serum total testosterone level (r=0.28; p=0.04), and luteinizing hormone/follicle stimulating hormone (r=0.29; p=0.04). CONCLUSIONS: Our findings indicate that PCOS is associated with altered NMCT. Prolonged NMCT predisposes patients to respiratory tract and middle ear infections, and clinicians should be aware of this.