Hearing loss in Takayasu's arteritis.

OBJECTIVES: Neurosensory hearing loss is well-documented in chronic autoimmune conditions such as systemic lupus erythematosus (SLE). However, the literature lacks data on the prevalence and characteristics of hearing impairment in Takayasu's arteritis (TAK). In this cross-sectional study, our principal objective was to systematically assess the auditory function of individuals diagnosed with TAK, against SLE patients and healthy controls (HC). METHODS: Age and gender matched TAK and SLE patients followed up in a tertiary centre along with healthy controls were included in a two-phase study. In the first phase, a questionnaire on ENT symptoms was administered to the patient (TAK: n=104 and SLE: n= 151) and HC (n=174) groups. In the second phase, patients (TAK: n=53 and SLE: n=33) and HC (n=45) underwent audiometric tests. RESULTS: The questionnaire survey revealed that both TAK and SLE patients reported hearing loss (27.9%, 25.8%, 7.4%, p<0.001), tinnitus (49%, 35.8%, 13.8%, p<0.001) and vertigo (46.2%, 33.8%, 16.7%, p<0.001) at significantly higher rates than HC. Audiometry results indicated that both TAK (30.2%) and SLE patients (18.2%) had increased hearing loss compared to HC (8.9%), however, only TAK patients were found to have significantly increased risk in age adjusted logistic regression analysis (OR= 3.915, 95%CI: 1.179-12.998, p=0.026). Hearing loss was mainly neurosensory in all groups. TAK patients were affected at both low (<6000 Hz) and high (>6000 Hz) frequencies, whereas SLE patients were affected only at high frequencies. Hearing loss was significantly associated only with older age. No association was observed with the anatomical location of vascular involvement or history of stroke. CONCLUSIONS: Our study reveals an increased prevalence of hearing loss in TAK. Further research is crucial to uncover the underlying causes.

Role of Preoperative Embolization in Surgical Treatment of the Carotid Body Paragangliomas.

In this study, we aimed to show the benefits of preoperative embolization on surgery of carotid body tumors.This is a retrospective study of the medical records of 20 patients who were operated for carotid body paragangliomas during 2011-2017. Computed tomography angiography (BTA) and/or magnetic resonance angiography (MRA) were performed for the entire patients. Patients were assessed according to the Shamblin classification. All patients were subjected to direct cerebral angiography by the femoral route 24 to 48 hours before the surgery and tumor embolization was performed in the appropriate cases (19 patients). The amount of hemorrhage and transfusion need during surgery has been reported. The ages of the patients ranged from 21 to 66, with an average of 45.65. In 20 patients ascendan pharyngeal artery was found as the main artery of tumor. No complications were seen after the embolization procedure. Tumor sizes ranged from 12 mm to 95 mm diameter (mean: 45, 5 mm). 10 patients (50%) were Shamblin type 1, 6 patients (30%) were Shamblin type 2, 4 patients (20%) were Shamblin type 3. In 5 patients (25%), the nerve (N. vagus or hypoglossus) was sacrificed due to cranial nerve involvement. Vagal and hypoglossal nerve sacrificed together in 4 patients.These patients' tumor sizes were bigger than 70 mm. Only in 1 patient, internal carotid artery injured and reconstructed with saphenous vein graft. Neurological deficit did not develop postoperatively. Bleeding was mean 275 mL (125 mL-700 mL). In conclusion, we believe that preoperative embolization of carotid paraganglioma is an effective procedure that helps surgeon during dissection with minimal blood loss. The embolization is relatively easy procedure without no additional complications.

A Rare Cause of Objective Tinnitus: Jugular Diverticulum.

The jugular bulb is a venous structure linking the sigmoid sinus with the internal jugular vein. Jugular diverticulum is a rare condition characterized by extraluminal outpouching from the jugular bulb. As the patients may be totally asymptomatic, but sensorineural symptoms such as sensorineural hearing loss, tinnitus and vertigo can also occur. Diagnosis of these patients can be made by some radiologic methods such as high-resolution computerized tomography, magnetic resonance imaging, or a novel radiologic technique flat panel computed tomography. In this paper we report a 22-year-old female patient with jugular diverticulum presenting with tinnitus complaint.

The effect of strabismus surgery on the dynamic balance in children with strabismus.

Purpose: To evaluate the effect of strabismus surgery on dynamic balance by using computerized dynamic posturography in children with strabismus. Methods: This study was designed as a prospective observational study. Hearing tests and complete ophthalmological examinations were performed for all subjects. Patients with moderate and severe amblyopia, hearing loss at any level, and/or any suspicion of balance impairment were excluded from the study. Postural stability evaluation was performed by computerized dynamic posturography including sensory organization test, adaptation test, and rhythmic weight shift test. All tests were applied preoperatively and in the postoperative 1st and 3rd months, respectively. Results: Fifteen female and twelve male pre-adolescents aged between 7 and 12 (9.67 ± 1.62 years) were included in the current study. In the sensory organization test, the preoperative visual ratio percentages (73.19 ± 14.95%) improved statistically significantly at the postoperative 1st and 3rd months (78.59 ± 16.21% and 81.44 ± 14.18; p = .026, p = .021, respectively). The preoperative toes up (110.66 ± 33,48) and toes down (81.46 ± 28.36) adaptation tests improved statistically significantly in the postoperative 3rd month (88.74 ± 20.94 and 63.36 ± 16.03; p < .001, p = .001, respectively). In the Rhythmic Weight Shift test, the postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the preoperative directional control (forward-backward) value (67.76 ± 11.38%) (p = .011). The postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the postoperative 1st-month directional control (forward-backward) value (68.43 ± 14.00%) (p = .028). Conclusion: Surgical treatment resulted in an improvement in the maintenance of dynamic balance in children with strabismus.

Evaluation of Inflammatory Blood Markers in Sinonasal Inverted Papilloma.

OBJECTIVE: Sinonasal inverted papillomas are benign neoplasms of the nasal cavity and paranasal sinuses. They have characteristic features such as a high risk of recurrence and possible malignant transformation. This study was conducted to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers. PATIENTS AND METHODS: Sixty-five patients who were diagnosed histologically as having sinonasal inverted papilloma and 65 age- and sex-matched healthy controls were included in the study. Inflammatory blood markers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) of the patient and control groups were compared. RESULTS: There were no statistically significant differences between the patients and controls for white blood cell, platelet, hemoglobin, neutrophil, and lymphocyte counts (P > .05). No statistically significant difference was found between the patients and controls for NLR, PLR, RDW, MPV, and PDW (P > .05). In the logistic regression analysis model, which was created to investigate the effects of inflammatory blood markers in determining the patient group, the increase in the NLR and decrease in the PLR were found to be statistically significant factors (P = .008, P = .039). CONCLUSION: This is the first study in the literature to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers, and the results suggest that NLR and PLR may be used to distinguish patients with sinonasal inverted papilloma from controls.

Malignant otitis externa.

OBJECTIVE: Malignant external otitis is a severe infection of the external auditory canal and skull base, which most often affects elderly patients with diabetes mellitus. This disease is still a serious disease associated with cranial nerve complications and high morbidity-mortality rate. Malignant otitis externa requires urgent diagnosis and treatment. The most effective treatment is to control the diabetes and to fight infection with the proper antibiotic and debridement necrotic tissue; sometimes, aggressive surgical management is done. We present our 5-year institutional experience in the management of this disease. The aim of this study was to present our experience with the management of malignant otitis externa. METHODS: All patients' records with malignant otitis externa during the last 5 years (2007-2012) were retrieved and reviewed. Diabetes mellitus profile, erythrocyte sedimentation rate, ear swab for culture and sensitivity, computed tomography, and scintigraphy using technetium 99 and gallium 67 were investigated for all patients. RESULTS: During the last 5 years (2007-2012), 10 patients with the diagnosis of malignant otitis externa were admitted to our clinic for investigation and treatment. There were 7 men and 3 women, all between 64 and 83 years of age, with severe persistent otalgia, purulent otorrhea, granulation tissue in the external auditory canal, and diffuse external otitis, and there were 4 patients with facial nerve palsy. Nine patients were confirmed to have a diabetes, and 4 of these 9 cases just had chronic renal failure and underwent dialysis; the remainder 1 case had no diabetes mellitus, but with chronic renal failure on dialysis. Ear swabs for culture and sensitivity usually revealed Pseudomonas aeruginosa. Local debridement and local and systemic antibiotic treatment were sufficient to control the disease. Facial nerve decompression was done in facial paralysis. Hyperbaric oxygen therapy was performed in facial nervy palsy cases. CONCLUSIONS: Malignant otitis externa is still a serious disease associated with cranial nerve complications and high morbidity-mortality rate. The most effective treatment is to control the diabetes and to fight infection with the proper antibiotic, debridement necrotic tissue, and sometimes aggressive surgical management. Monitoring of therapy response is done through normalization of erythrocyte sedimentation rate, control of diabetes mellitus, and improvement of computed tomography and radioisotope scanning.

Inflammatory myofibroblastic tumor of the parotid gland.

An inflammatory myofibroblastic tumor, previously known as an inflammatory pseudotumor, is an uncommon neoplasm. This tumor, which has characteristic morphologic and immunohistochemical features, is mostly seen in the lung. We present a rare case of an inflammatory myofibroblastic pseudotumor of the parotid gland. A 45-year-old woman presented with a 4-month history of a swelling in her right parotid region. A partial parotidectomy with preservation of the facial nerve branches was performed. The incidence of inflammatory myofibroblastic tumor in the parotid gland is low, and local resection is currently the best treatment. A prolonged postoperative follow-up period is necessary for patients with inflammatory myofibroblastic tumor. Inflammatory myofibroblastic tumor of the parotid gland is discussed with a brief literature review.

Rapidly progressive thyroid mass: amyloid goiter.

Amyloidosis is a disease of unknown etiology characterized by the accumulation of an amorphous proteinaceous material in various organs and tissues of the body. Amyloid goiter is an exceedingly rare pathologic condition due to massive amyloid infiltration of the thyroid tissue. Amyloid goiter occurs in association with both primary and secondary systemic amyloidosis, more commonly in the latter. Preoperatively, it simulates a multinodular goiter, and surgical intervention is often necessary to establish a diagnosis and to relieve compressive symptoms of a neck mass. We present the case of an 85-year-old female patient who presented with a rapidly enlarging goiter. Histologic examination confirmed amyloid goiter.

Investigation of Toll-like Receptor-2, -3 and -4 Gene Expressions in Larynx Squamous Cell Carcinoma.

Objective: Despite all the recent advancements, larynx cancer has shown no improvement in survival rates. The aim of this study was to investigate the expressions of toll-like receptor (TLR)-2, -3, and -4 genes, and determine any relationships with the histopathologic characteristics of the disease. Methods: This retrospective study included 50 subjects who underwent total or partial laryngectomy with an open surgical method for larynx squamous cell carcinoma. Measurements of TLRs-2, -3, and -4 expression values were taken with quantitative real time-polymerase chain reaction in normal tissue and tumor tissue samples of the patients. Results: Evaluations were made of TLR-2, -3, and -4 mRNA expressions according to 2-ΔΔCT calculations in 50 subjects with larynx cancer. When the tumor tissue was compared with the healthy tissue from the same subjects, reductions were determined in TLR expression in 86%, 84%, and 82%, respectively. This reduction in each gene expression was statistically significant (p<0.001). No statistically significant correlation was determined between the change in TLR-2, -3, and -4 expression and the histopathologic characteristics of the disease. Conclusion: The data obtained in this study demonstrated that TLR-2, -3, and -4 expressions were reduced in larynx squamous cell cancer. The results of further studies targeting these genes would be useful in the diagnosis and treatment of the disease.

Unusual location of primary hydatid cyst: soft tissue mass in the parapharyngeal region.

Hydatid cyst is a cyclozoonotic infection caused by the cestode Echinococcus granulosus. Hydatid cyst in the head and neck region is very rare, even in countries where echinococcus infestation is endemic. We report the case of a 17-year-old male patient presenting with a hydatid cyst in the parapharyngeal and neck region. There was no pulmonary or hepatic involvement. The definitive therapy comprised excision of the cystic mass and postoperative medical treatment.

The effect of lidocaine, bupivacaine and ropivacaine in nasal packs on pain and hemorrhage after septoplasty.

We aimed to investigate the effects of local anesthetics soaked in Merocel nasal packs on hemorrhage and pain after septoplasty. The methodology includes a prospective double-blind study that was conducted in patients undergoing septoplasty because of nasal septal deviation. The study included 143 patients. The patients were divided into four groups. Each group received 1% lidocaine + 0.000625% adrenalin, 0.375% ropivacaine, 0.25% bupivacaine as study groups or 0.9% sodium chloride as a control group in their Merocel packs postoperatively. The local anesthetics or sodium chloride were reapplied at the eighth postoperative hour. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. The statistical analysis was performed using two sided t test on each patient group at each time point. The results included the patients in the control group needing rescue drug most often. There was no statistically significant difference between bupivacaine and lidocaine plus adrenalin in the patients who requested rescue drug. The patients in the ropivacaine group requested rescue drug more frequently than the bupivacaine and lidocaine plus adrenalin groups. Bupivacaine group had significantly better pain scores versus control group at all intervals except for the first postoperative hour.The bupivacaine group had better pain scores versus ropivacaine and lidocaine plus adrenalin groups in the 4th, 8th and the 24th hours. The bupivacaine group had better pain scores versus lidocaine plus adrenalin in the 12th, 16th and the 20th hours. The ropivacaine group had significantly better pain scores versus control group in the 8th, 12th, 16th, 20th and 24th postoperative hours. The ropivacaine group scored better than lidocaine plus adrenalin group just in the 16th hour. The lidocaine plus adrenalin group had significantly better pain scores versus control group in 4th and 12th hours. There was no statistically significant difference between the study groups in terms of postoperative hemorrhage. We concluded that bupivacaine use in nasal surgery provides better analgesia at least in the first 8 h period and does not cause more bleeding. Topical bupivacaine application to nasal packs should be considered after septoplasty.

Encephalomalacia in the frontal lobe: complication of the endoscopic sinus surgery.

Encephalomalacia is the softening or loss of brain tissue after cerebral infarction, cerebral ischemia, infection, craniocerebral trauma, or other injury. The term is usually used during gross pathologic inspection to describe blurred cortical margins and decreased consistency of brain tissue after infarction. Multicystic encephalomalacia refers to the formation of multiple cystic cavities of various sizes in the cerebral cortex of neonates and infants after injury, most notably perinatal hypoxic-ischemic events. Chronic sinusitis has become one of the most common diseases in otolaryngology practice. Many of these patients can be managed successfully with medical therapy. Those who fail intensive medical therapy may be candidates for functional endoscopic sinus surgery (ESS). This procedure has variable complication rates and can have some serious consequences. Serious complications of functional ESS are very rare, but cerebrospinal fluid leak, meningitis, hemorrhage, infection, or vision loss has been reported in a few cases. In this study, we present a 57-year-old man with encephalomalacia after a penetrating brain injury incurred during ESS.

Intraparotid facial nerve neurofibroma in neurofibromatosis type 1.

Benign tumors of the nerve sheath are of 2 types: schwannoma and neurofibroma. Neurofibromas are most commonly found with neurofibromatosis type 1 and characterized by incorporation of the nerve fibers within their matrix. Both benign and malignant tumors can affect the facial nerve. These tumors can be intrinsic or extrinsic; in other words, it can originate from the facial nerve itself or from a contiguous structure or a metastatic disease. Actually, extrinsic tumors are far more common than intrinsic tumors. Intraparotid location of benign tumors of the facial nerve sheath is considered a rare event compared with intratemporal location.

Unusual manifestations of bilateral carotid artery dissection: Dysphagia and hoarseness.

Dissection of the carotid artery can occur intracranially or extracranially, although dissections tend to affect extracranial segments of the arteries much more commonly than intracranial segments. Carotid artery dissection (CAD) is most common in middle-aged women. Although not completely known, the main risk factors related to carotid artery dissection are genetic and environmental factors, traumatic events, cervical manipulation, migraine, recent infections, hyperhomocysteinemia, and hereditary connective tissue disorders. Although some cases of bilateral internal CAD have been reported, spontaneous bilateral dissections are rare. Prolonged hoarseness is usually due to using the voice either too much, too loudly, or improperly over an extended period of time. Disorders leading to dysphagia may affect the oral, pharyngeal, or esophageal phases of swallowing. In this study we report on a patient with bilateral CAD who presented to our clinic with dysphagia and hoarseness.

Primary tuberculosis involving epiglottis: a rare case report.

The case of a 29-year-old patient with active laryngeal tuberculosis predominantly involving the epiglottis, without pulmonary disease, is presented. The predominant symptoms are dysphagia, odynophagia, and hoarseness. Laryngeal carcinoma, which shares almost the same symptoms and signs, should be ruled out immediately. Laryngeal tuberculosis is discussed with a brief literature review.

Detection of cisplatin-induced ototoxicity with transient evoked otoacoustic emission test before pure tone audiometer.

Our aim was to investigate cisplatin ototoxicity with transient evoked otoacoustic emission (TEOAE) test before it is seen with pure tone audiometer. In our study, we compared the hearing of the patients who are receiving 100 mg/m(2) 4-cycle cisplatin for lung cancer, with pure tone audiometer and transient evoked otoacoustic emission test in 1,000, 2,000 and 4,000 Hz. We found 55% hearing decrease with pure tone audiometer in patients that are receiving 100 mg/m(2) 4-cycle cisplatin for lung cancer. We also established emission amplitude decrease with TEOAE test in 85% of the patients. When we compare the patients' pure tone audiometer in 1,000, 2,000 and 4,000 Hz and TEOAE amplitude changes we did not find statistically significant results (P > 0.05), but when we compare the patients' TEOAE amplitude changes in 1,000, 2,000 and 4,000 Hz with control group we found statistically significant results (P < 0.05). Our results show that cisplatin ototoxicity could be find out with TEOAE test before it is seen with pure tone audiometer.

Epidermal inclusion cyst of external auditory canal.

Epidermal inclusion cyst is a benign cyst filled with keratin fibers, and its wall has nearly the same characteristics as the epidermis. It is commonly seen in the skin and has the tendency to slowly grow toward deeper epidermis parts and to cause cystic expansion. We report a 23-year-old woman who presented with right external otitis lasting for 2 months. The patient's complaints did not respond to treatment even after parenteral antibiotic therapy. Surgical exploration revealed epidermal inclusion cyst of the ear canal. This pathologic entity is discussed in the light of current literature.

Composite cartilage island grafts in type 1 tympanoplasty: audiological and otological outcomes.

Tympanoplasty is a surgical procedure used for eradicating chronic middle ear infection and for reconstructing hearing in infected ears. Independent from the graft placing technique, the atrophy and the insufficiency of the graft material would be seen.For cases at high risk for failure, such as recurrent perforations, total perforations, and severely atelectatic tympanic membranes, many surgeons have used cartilage as a grafting material because of its increased stability and resistance to negative middle ear pressure. Various cartilage grafting techniques have been described, including the palisade, cartilage island, and cartilage shield.In our study, we investigated audiological and otological outcomes of tympanoplasty type 1 with composite cartilage island grafts. Between 2004 and 2008, 100 cases of composite cartilage island tympanoplasty were identified. A total of 74 patients were attended to in this study. Graft take was evaluated in all patients, and postoperative complications were noted. Hearing results were analyzed by comparing the preoperative and postoperative pure-tone average air-bone gap. Graft take was accomplished in 72 patients (97.29%). There was no graft lateralization or displacement in the middle ear. The mean postoperative pure-tone average air-bone gap improvement was 20.2 dB at 500 Hz, 23.58 dB at 1000 Hz, 22.23 dB at 2000 Hz, and 24.79 at 4000 Hz.Our study indicates that composite cartilage island tympanoplasty has a high degree of reliability and excellent hearing improvement especially in patients at high risk for graft failure.

Laryngotracheal reconstruction at relapsing polychondritis.

Relapsing polychondritis (RP) is characterized by chronic, recurrent episodes of inflammation with eventual degeneration of cartilaginous tissues including the ears, nose, larynx, trachea, and so on. Tracheobronchomalacia and airway stenosis may be seen in RP. In this report, we describe 3 female patients presenting with progressive dyspnea owing to laryngotracheal involvement of RP who underwent laryngotracheal reconstruction.