Endoscopic Lateral Osteotomy in Rhinoplasty.

OBJECTIVES: The purpose of this study was to investigate the advantages of endoscopic lateral osteotomy, to evaluate the effects of the periosteal elevation on ecchymosis and to search the reasons for the ecchymosis and the intranasal mucosal tears. METHODS: On a randomly chosen side a subperiosteal tunnel was elevated, on the other side a subperiosteal tunnel was not elevated. Bilateral lateral osteotomies were performed. Internal nasal packing was not used. The post-operative care was similar for all patients. The patients were evaluated on the third post-operative day. The intranasal mucosal tears, the lateral osteotomy cut on the periosteal elevation side were examined using endoscopes. The degree of ecchymosis was determined by 2 other surgeons, who were unaware of the elevated side, using the grading system adapted from Hoffman et al. RESULTS: The intranasal mucosal injury was seen in 16 of non-elevated side whereas it was 14 on the periosteal elevated side. Endoscopy showed the perforating arteries and elevation of the periosteum caused rupture and oozing from these arteries which might be a cause for ecchymosis. Ecchymosis was more severe on the side with subperiosteal tunnel in 6 patients; whereas only in 2 patients it was more severe on the side with no subperiosteal tunnel elevation while in 12 patients the degree of ecchymosis was the same on both sides. CONCLUSION: Endoscopy gives a great opportunity to visualize the lateral osteotomy site. Besides the lateral osteotomy cut, the arteries and the intranasal mucosal injury can be visualized. Periost elevation increases the severity of ecchymosis due to the rupture of the perforating arteries, not due to the trauma of the angular artery. Intramucosal tears do not increase the severity of the ecchymosis.

Comparison of the Efficacy of Video Head Impulse and Bi-Thermal Caloric Tests in Vertigo.

OBJECTIVE: To compare video head impulse test (vHIT) and caloric test efficacy in decompensated and compensated vertigo patients and to further investigate whether vHIT alone can be used as a diagnostic tool in vertigo. METHODS: This study included 25 patients diagnosed with vertigo and without any previous history of vertigo or hearing loss before their admission to our clinic. The control group consisted of 16 healthy adult volunteers. Patients were classified into 2 groups, compensated and decompensated. Video head impulse test and caloric tests were performed and the results were compared between the groups. RESULTS: The difference of caloric test values between control-compensated groups and compensated-decompensated groups was statistically significant (P < .001, Pearson χ2). However, there was no statistically significant difference between the compensated and control groups according to vHIT gain asymmetry values (P = .087). In the very early stages of the disease with spontaneous nystagmus, the diagnostic significance of vHIT was similar to that of the caloric test. When both sides were compared, vHIT gain asymmetry values were close to the caloric test asymmetry values. In the compensated stage, caloric test was superior to vHIT in differentiating compensated vestibular pathologies. When vHIT sensitivity was evaluated according to the bi-thermal caloric test results, the sensitivity of the vHIT gain asymmetry value was 85.71% and 23.08% for decompensated and compensated patients respectively. CONCLUSION: In the early decompensated stages of the disease with spontaneous nystagmus, vHIT shows similar diagnostic accuracy to that of the caloric test. Since patients can tolerate vHIT more easily, our results suggest that vHIT can be considered as a primary evaluation method in the early (decompensated) period of the disease and should be preferred over the caloric test during the acute phase. Caloric test is more reliable at the compensated stage. Video head impulse test is inadequate in evaluating the compensated vestibular hypofunctional states after compensation has been restored. LEVEL OF EVIDENCE: Level 2b.

Does Calcium Dobesilate Have Therapeutic Effect on Gentamicin-induced Cochlear Nerve Ototoxicity? An Experimental Study.

HYPOTHESIS: The ototoxic effects of aminoglycosides are well known. Gentamicin carries a substantial risk of hearing loss. Gentamicin is widely used to combat life-threatening infections, despite its ototoxic effects. Calcium dobesilate is a pharmacologically active agent used to treat many disorders due to its vasoprotective and antioxidant effects. We investigated the therapeutic role of calcium dobesilate against gentamicin-induced cochlear nerve ototoxicity in an animal model. METHODS: Thirty-two Sprague Dawley rats were divided into four groups: Gentamicin, Gentamicin + Calcium Dobesilate, Calcium Dobesilate, and Control. Preoperative and postoperative hearing thresholds were determined using auditory brainstem response thresholds with click and 16-kHz tone-burst stimuli. Histological analysis of the tympanic bulla specimens was performed under light and transmission electron microscopy. The histological findings were subjected to semiquantitative grading, of which the results were compared between the groups. RESULTS: Gentamicin + Calcium Dobesilate group had, on average, 27 dB better click-evoked hearing than Gentamicin group (p < 0.01), whereas the difference was not significant with 16-kHz tone-burst stimuli (p > 0.01). Histologically examining the Control and Calcium Dobesilate groups revealed normal ultrastructural appearances. The Gentamicin group showed the most severe histological alterations including myelin destruction, total axonal degeneration, and edema. The histological evidence of damage was significantly reduced in the Gentamicin + Calcium Dobesilate group compared with the Gentamicin group. CONCLUSION: Adding oral calcium dobesilate to systemic gentamicin was demonstrated to exert beneficial effects on click-evoked hearing thresholds, as supported by the histological findings.