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 radiofrequency thermal ablation method on nasal mucociliary activity in patients with inferior turbinate hypertrophy.

OBJECTIVES: This study aims to investigate the effect of radiofrequency thermal ablation (RFTA) treatment on nasal mucociliary activity before and after treatment in inferior turbinate hypertrophy. PATIENTS AND METHODS: Thirty-nine patients (21 males, 18 females; mean age 36.3±13.9 years; range 16 to 67 years) admitted to our clinic with complaint of nasal obstruction and diagnosed with stromal inferior turbinate hypertrophy were included in this study. Effect of RFTA treatment on nasal mucociliary activity was investigated by saccharine test before treatment and two months after treatment. Grade of nasal obstruction was evaluated by visual analog scale (VAS) before treatment and two months after treatment. Results were compared with paired t-test. RESULTS: Mean mucociliary activity times were 9.8±4.4 minutes before treatment and 9.6±4.1 minutes two months after treatment, and the difference between two tests was not statistically significant (p=0.3). Mean VAS scores for nasal obstruction were 6.5±1.2 before treatment and 3.8±1.0 two months after treatment, and the difference between two results was statistically significant (p=0.001). Difference between sexes in terms of saccharine transit time and VAS values before and after treatment was not statistically significant (p>0.05). CONCLUSION: It was detected that RFTA has no adverse effect on mucociliary activity in the treatment of inferior turbinate hypertrophy, and this method is notably effective in relieving the nasal obstruction caused by inferior turbinate hypertrophy.

Ear protrusion after tympanoplasty and the use of mastoid dressing.

OBJECTIVES: This study aims to assess possible wound complications of tympanoplasty and tympanomastoidectomy with or without postoperative mastoid dressing. PATIENTS AND METHODS: A total of 37 patients (22 females, 15 males; mean age: 23.88 years; range 9 to 64 years) who underwent middle ear or mastoid operations via postauricular incision were included in this prospective, randomized, controlled study. The patients were divided into two groups as having mastoid dressing (n=17) and nonmastoid dressing (n=20). Through a close follow-up, postoperative complications were noted and distance from mastoid scalp and auricular rim was measured. RESULTS: The mean mastoid-helix distance of non-mastoid dressing group was found 17.2 mm in operated and 16.9 mm in non-operated ears. The mean mastoid-helix distance of mastoid dressing group was 15.53 mm in operated ears and 16.47 mm in non-operated ears. Skin erythema was seen in a patient. There was no statistically significant increase in mastoid-helix distance (p>0.05). CONCLUSION: Tympanoplasty with or without mastoidectomy does not cause postoperative complication or protrusion of the ear, even if no mastoid dressing is used. Our study results suggest no benefit of mastoid dressing after tympanoplasty with or without mastoidectomy.

The effect of retinyl palmitate on healing of benign vocal fold lesions.

The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.

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.

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.

Combined medical and surgical therapy improves olfaction in patients with nasal polyposis.

OBJECTIVE: The aim of the present study was to evaluate the outcomes of combined oral steroid, nasal steroid and surgical therapy in patients with impaired olfaction due to nasal polyposis. PATIENTS AND METHODS: This prospective observational study was undertaken in the otolaryngology department of a university hospital. During the study, 19 nasal polyposis patients were evaluated three times, i.e. before oral steroid therapy, before surgery (after steroid therapy) and after surgery, with smell identification tests, acoustic rhinometry, subjective smell score, endoscopic grading and a visual analog scale for nasal obstruction. RESULTS: All subjective and objective measures were significantly improved after medical and surgical therapy (p < 0.01). The median smell identification score improved from 2 (interquartile range 0-4) to 5 (interquartile range 4-7) after combined therapy. Smell identification scores were found to be modestly correlated with all other examination findings. CONCLUSION: Combined therapy seems efficient in improving smell identification scores of nasal polyposis patients.

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.

Laryngeal fracture due to blunt trauma presenting with pneumothorax and pneumomediastinum.

AIM: Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. CASE: A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. CONCLUSION: Pneumomediastinum is a rare result of a laryngeal fracture and if not suspected, the fracture can easily be missed. It should be kept in mind after blunt cervical trauma with pneumomediastinum and/or pneumothorax. Direct endoscopy and cervical tomography may be necessary for the differential diagnosis.

[Hearing aid use and patient satisfaction]. / Isitme cihazi kullanimi ve hasta memnuniyeti.

OBJECTIVES: In this study, we assessed the hearing aid usage ratios and durations, patient satisfaction and the probable causes of disuse if they are not used. PATIENTS AND METHODS: A questionnaire with 16 questions was applied to the patients who were prescribed hearing aids in our clinic between January 2007 and December 2009. A total of 517 patients were called by phone. Hundred and seventy-nine of the patients (75 females, 104 males; mean age 60±23 years; range 17 to 94 years) participated in the trial. Hearing aid usage ratios and patients' satisfaction were determined and the factors influencing usage were statistically investigated. RESULTS: Hundred and forty-two of the patients used their hearing aids regularly and 37 of the patients either used their aids rarely or never used them. The most common cause reported for disuse was the frequent noise coming from the hearing aid. CONCLUSION: Failure to explain the usage of the hearing aids to the patients and age over 70 years have a statistically significant negative effect on the duration of hearing aid use and patient satisfaction.

Chondroid syringoma: a case report.

BACKGROUND: Chondroid syringoma is a benign skin adnexal tumor. The reported incidence of chondroid syringoma among primary skin tumors is low and has been reported at 0.01-0.098%. CASE: A 57-year-old woman presented with a 10-year history of a slowly growing lump on her philtrum. Fine needle aspiration cytology was performed. The smears showed cohesive groups of round cells embedded in a chondromyxoid ground substance. A diagnosis of benign appendageal tumor of the skin was made. Surgical excision of tumor was done. Histopathologic examination was consistent with chondroid syringoma. CONCLUSION: Chondroid syringoma should be included in the differential diagnosis of a slowly growing nodule on the head or neck. The diagnosis can be confirmed by means of fine needle aspiration cytology. The treatment of choice is local excision.

Do children with adenotonsillar hypertrophy have lower IGF-1 and ghrelin levels than the normal children?

OBJECTIVE: This study was designed to determine serum insulin-like growth factor-1 (IGF-1) and plasma ghrelin levels in male children with adenoid and tonsillar hypertrophy and compare them with healthy controls. METHODS: This study included 29 male prepubertal children between the ages of 6.5 and 10 years (mean age 8.8 +/- 2.5 years) with obstructive adenoid and tonsillar hypertrophy and 20 normal male controls between the ages of 5.7 and 10.8 years (mean age 8.2 +/- 2.9 years). Plasma ghrelin and serum IGF-1 levels were measured at 8.30, in the morning. RESULTS: Children with adenoid and tonsillar hypertrophy had significantly depressed serum IGF-1 levels (203 +/- 150 ng ml(-1)) and plasma ghrelin levels (175 +/- 66 pg ml(-1)) compared with healthy controls (354 +/- 242 ng ml(-1) and 243 +/- 93 pg ml(-1), respectively, P < 0.05). CONCLUSION: Depressed levels of ghrelin in children with adenoid and tonsillar hypertrophy lead to decreased appetite and insufficient energy intake. Lower serum levels of IGF-1 in children with adenoid and tonsillar hypertrophy may be secondary to deficient growth hormone stimulation by ghrelin.

Oncocytic lipoadenoma of the parotid gland: a case report with fine needle aspiration cytology findings.

Oncocytic lipoadenoma of the salivary gland is a rarely encountered tumor. A 56-year-old man presented with a two-year history of a slow-growing mass of the left parotid gland. Computed tomography scan with contrast showed a 7x6.5x6 cm well-circumscribed solid parotid mass of the left superficial and deep lobe. Fine-needle aspiration yielded oncocytic cells exclusively, suggesting Warthin tumor or an oncocytoma. Left total parotidectomy was performed. A diagnosis of oncocytic lipoadenoma was made. At six-month follow-up no evidence of recurrence has been noted. Oncocytic lipoadenoma should be considered in the differential diagnosis of oncocytic proliferations and oncocytic tumors in the parotid gland.

The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients.

OBJECTIVE: To assess the prevalence of obstructive sleep apnoea syndrome (OSAS) in AS patients. METHODS: Thirty-one patients with AS were included in the study. The demographic data, spinal mobility measures and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were recorded for each patient. All participants underwent one night of sleep recording, which was performed using a polysomnography (PSG). Pulmonary function test (PFT) was performed for all subjects and symptoms of OSAS were questioned. RESULTS: Seven (22.6%) of 31 AS patients had OSAS according to PSG assessments. The mean BMI, disease duration, BASDAI score, neck circumference and occiput-wall distance were higher in patients with OSAS, but the differences were not significant. The mean ages of patients with OSAS were significantly higher than the patients without OSAS. The prevalence of OSAS in patients under the age of 35 years was found to be 6.3%, whereas the prevalence of OSAS in patients at the age of 35 years or over was 40.0% (P = 0.037). The prevalence of OSAS in AS patients with a disease duration <5 years was 11.8% and its prevalence in AS patients with a disease duration of >or=5 years was 35.7% (P = 0.198). PFT was restrictive in 16 (53.3%) patients and obstructive in none. CONCLUSIONS: The prevalence of OSAS in AS patients is higher than reported in the general population. The diagnosis of OSAS should be kept in mind and OSAS symptoms should be considered especially in AS patients at the age of >or=35 years and in AS patients with a disease duration of >or=5 years.

A neck mass with brachial plexus injury: Pott's disease.

Tuberculous osteomyelitis of the spine is most commonly seen in lower thoracic and lumbar vertebrae. Cervical spine tuberculosis is a very rare condition, and it represents a very small part of all patients with Pott's disease. We present a case with thoraco-cervical Pott's disease, with left-sided neck mass and left arm and hand weakness and numbness. The patient had a paraspinal abscess under the sternocleidomastoid muscle that was compressing the brachial plexus.

Can Rh antigens be a risk factor in noise-induced hearing loss?

Noise-induced hearing loss (NIHL) is one of the most common occupational problems and is one of the main causes of deafness. Many factors cause NIHL. Individual susceptibility is one of them. Rhesus (Rh) antigens and ABO blood groups can be factors in determining individual susceptibility. We aim to investigate the relationship between the Rh antigens and NIHL. The study was conducted in 438 factory workers who had been exposed to a noise level more than 85 dB for 8 h a day for a period of >/=15 years. The audiologic results and blood groups were obtained from the individual health records of the factory workers. We determined NIHL in 236 (53.9%) workers. Two hundred and nineteen (55.4%) of Rh-positive workers and seventeen (39.5%) of Rh-negative workers have NIHL, and the difference between the two groups was statistically significant (P < 0.05), whereas no statistically significant difference was determined between the NIHL and ABO blood groups. In conclusion, we suggest that the people with Rh-positive blood group are more prone to develop NIHL.

The effects of caspofungin and voriconazole in an experimental fungal infection of the ear due to Aspergillus.

The purpose of the study was to evaluate the effectiveness of caspofungin and voriconazole in the treatment of experimental Aspergillus otitis media in an experimental rabbit model. A total of 30 New Zealand white rabbits were divided into four treatment groups and one control group. The rabbits were immunosuppressed by cyclophosphamide and triamcinolone acetonide. The right ear of each rabbit was infected by an injection of the inoculum of 0.1 ml (8.6 x 103 CFU/0.1 ml) of Aspergillus fumigatus into the middle ear cavity. At 72 h after the inoculation, amphotericin B 1 mg/kg per day (n = 6), itraconazole 10 mg/kg per day (n = 6), voriconazole 10 mg/kg per day (n = 6) and caspofungin 5 mg/kg per day (n = 6) were injected to each treatment group. No antifungal drug was administered to the control group (n = 6). Clinical and histopathological examination scores and microbiological analysis of middle ear mucosa were compared.There was statistically significant difference in the clinical scores, histopathological scores, and mean CFU/g between the treatment and control groups (P < 0.05). There was no statistically significant difference among the treatment groups in the clinical and histopathological scores, whereas there was statistically significant difference in the mean CFU/g (P < 0.05). The mean CFU/g of amphotericin B and caspofungin groups were similar and both were lower than the itraconazole and voriconazole groups. Also, the mean CFU/g of voriconazole group was lower than the itraconazole group (P < 0.05). Caspofungin and voriconazole were demonstrated at least as effective as amphotericin B and itraconazole. We suggest that caspofungin and voriconazole may be considered for the treatment of fungal infection of the ear.

Incidence of auditory neuropathy among the deaf school students.

OBJECTIVE: We aimed to determine the incidence of auditory neuropathy (AN) among the deaf school students that have severe hearing loss. METHOD: All students having severe hearing loss constituting a total of 75 at Deafness school in Afyon Province of Turkey were enrolled in the study. The etiological factors about the hearing loss were determined by performing an individual file survey and by interviewing the teachers and parents. First, all the children were subjected to an otolaryngologic examination. Then, auditory brainstem response (ABR) and transient evoked otoacoustic emissions (TEOAE) tests were done to all students enrolled in the study. RESULTS: The ages of the children were between 6 and 17 (mean age 11.9) and 32 (42.9%) of them were girls and 43 (57.1%) were boys. Three cases (4%) were diagnosed as AN in our study, however, no risk factors were determined in two of them. A history of hearing loss following a vaccination was found in only one patient. CONCLUSION: Our data show that the incidence of AN in the children with severe hearing loss is not negligible. Therefore, our results suggest that automatic ABR should be also used with OAE as a routine application in the neonatal screening programmes, since the solely use of OAE in the neonatal screening programmes may result in the delay of the diagnosis of the children with AN.