Functional outcomes and caloric response changes after endolymphatic sac decompression.

OBJECTIVE: To evaluate caloric response changes after endolymphatic sac decompression (ESD), together with hearing outcomes and the functional benefit of the operation. METHODS: A retrospective chart review of subjects who underwent endolymphatic sac decompression at a tertiary referral centre was performed. Data on audiological results, caloric testing, and functional level scale of the patients were analysed. RESULTS: Twenty-eight patients who met our criteria were eligible for enrolment in the study. The average follow-up after surgery was 25 months (range, 13-41). Postoperative pure-tone threshold averages and reduced vestibular response values (RVR) were not significantly altered by ESD; whereas, functional level scores improved significantly. CONCLUSION: Endolymphatic sac decompression is a surgical procedure that preserves hearing and vestibular function, and improves the daily functional level of patients with Ménière's disease. ESD can be preferred both in bilateral and unilateral disease because it does not alter vestibular function and preserves hearing.

Olfactory function assessment of migraine patients by using the Sniffin' sticks test: A clinical study.

OBJECTIVE: This as a cross-sectional controlled clinical study. We hypothesis that the olfactory functions in migraine patients may differ from the healthy controls. In this study, we evaluated the olfactory functions by using a Sniffin' Sticks test battery, which is a reliable and semi quantitative test to evaluate for olfactory dysfunction. METHODS: Patients above 18 years of age who had migraine received a definitive diagnosis of migraine from experienced headache specialists based on the criteria of The International Classification of Headache Disorders-3 were included. Odor threshold, discrimination, and identification parameters were assessed using the "Sniffin' Sticks" test. RESULTS: One-hundred and one migraine patients (age [mean ± SD], 36.9 ± 10.4 years; range, 18-60 years) and sixty healthy volunteers (age 34.5 ± 13.2 years, range 18-65 years) participated in our study. The median odor threshold score [percentiles 25th-75th] was 8.3 [6.5-9.8] for the migraine group during attack free period and 4.5[3.6-6.0] for the control group. It was found that the migraine group had a median odor discrimination score of 10.0 [10.0-13.0] and the control group 12.0 [11.0-13.0]. These differences were statistically significant (p < 0.001 and p = 0.032 respectively). The median odor discrimination and identification scores were statistically significant higher for the participants with higher educational level group than in those of lower educational group (p < 0.0001). The median odor discrimination and identification scores of those without allodynia (12.0 [10.0-14.0] and 13.0 [10.0-13.0] respectively) were higher than that of those with allodynia (11.0 [9.0-12.0] and 11.0 [10.0-13.0] respectively) (p = 0.037 and p = 0.034 respectively). CONCLUSIONS: We found that the odor thresholds, discrimination and identification scores of the migraine group demonstrate differences from those of the healthy group and in relation to allodynia.

Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis.

OBJECTIVES: To evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis. MATERIALS AND METHODS: This is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared. RESULTS: Eleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4-47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5-4 khZ and BC 0,5-3 kHz thresholds was observed between both techniques. CONCLUSION: Even middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.

Olfactory dysfunction in patients with cluster headache.

OBJECTIVE: Cluster headache (CH) is a primary headache characterized by strictly unilateral, short-lasting severe headache attacks accompanied by at least one ipsilateral autonomic symptom. Our study aimed to determine whether CH patients had olfactory dysfunction and to correlate it with clinical characteristics. MATERIALS AND METHODS: Twenty patients and 57 healthy volunteers were included in the study. All participants were examined in the otorhinolaryngology outpatient clinics to exclude other clinical problems causing olfactory dysfunction. The Sniffin' Sticks test was performed, and threshold (T), discrimination (D), identification (I) scores, and TDI global olfactory score were evaluated. RESULTS: The CH patients had significantly lower threshold scores than healthy controls (6.9 ± 1.70 vs. 7.8 ± 1.08, p = 0.007). The mean threshold scores of CH patients during in-bout (n = 9) were significantly lower than CH patients during out-of-bout (n = 11) in subgroup analysis (5.9 ± 1.16 vs. 7.6 ± 1.76, p = 0.038). CH patients with left-sided headache had significantly lower discrimination scores compared to CH patients with right-sided headache (12.8 ± 1.24 vs. 14.4 ± 1.51, p = 0.03). CONCLUSION: There is marked impairment in olfactory function in CH patients compared to healthy controls.

Plasma levels of inflammatory mediators in vestibular migraine.

Objectives: Vestibular migraine (VM) is an under-recognized entity with substantial burden for the individual and society. The underlying mechanism of VM and its distinction from other migraine mechanisms still remain unclear. Inflammatory pathways have been suggested to contribute to vestibular migraine. Our aim was to further investigate the possible role of inflammation in the pathophysiology of VM.Methods: We recruited 30 patients with VM diagnosed according to ICHD-3 criteria and 50 gender- and age-matched controls. Blood samples were obtained from 11 VM patients during an attack and from 13 VM patients under prophylactic treatment. Plasma levels of calcitonin gene related peptide (CGRP), neurokinin A (NKA), substance P (SP), NLRP1, NLRP3, caspase-1, IL-1ß, IL-6, TNF-α and NFκB were measured by ELISA.Results: IL-6 levels were significantly reduced in VM patients, whereas levels of other inflammation parameters were comparable to those of healthy controls. Levels of inflammatory mediators were not correlated with clinical parameters. Likewise, there were no significant differences among VM patients with and without headache attack and prophylactic treatment.Conclusion: Our results argue against involvement of systemic inflammation in the pathophysiology of VM.

Integrative analysis of mRNA and microRNA expression profiles in laryngeal squamous cell carcinoma.

Larynx cancer is a therapeutically challenging disease. Rapidly evolving experimentally validated data have significantly improved our understanding of the complex role of numerous RNA, DNA, and proteins that play a role in the development and progression of cancer. Based on the insights from approximately two decades of research, it seems clear that microRNAs (miRNAs) have revolutionized our concepts related to the main role of noncoding RNAs in different cancers' progression, development, and metastasis. Mechanistically, miRNAs have been reported to regulate different RNAs and finally protein-coding genes. The expression profiling of miRNAs and messenger RNA (mRNAs) was conducted for a deeper analysis of the miRNAs and mRNAs which play an essential role in larynx cancer. Downregulation or upregulation over twofolds in the miRNAs was considered to be significant, and that of sixfolds or below was considered to be significant for the mRNAs. In accordance with this approach, the expression levels of 43 miRNAs were increased in this study, whereas the expression levels of 129 were decreased. Accordingly, all the genomic expression studies provided evidence of upregulation of 97 genes, whereas 128 genes were found to be downregulated. Among these miRNAs, hsa-miR-20a-3p and hsa-miR-1972 were noted to be important in the etiology of larynx cancer.

Assessment of the Olfactory Function in Patients With Idiopathic Intracranial Hypertension Using the Sniffin' Sticks Test: A Case-Control Study.

OBJECTIVE: Despite the lack of recognition in clinical practice, there is increasing evidence that patients with idiopathic intracranial hypertension may suffer from hyposmia. The current case-control study aims to evaluate olfactory dysfunction in a large series of patients with idiopathic intracranial hypertension. METHODS: All subjects, 44 idiopathic intracranial hypertension patients and 57 healthy controls, underwent olfactory function assessment using standardized "Sniffin' Sticks" test at a tertiary referral center of a university hospital. Threshold, discrimination, identification, and total threshold-discrimination-identification scores have been determined and analyzed statistically. RESULTS: Idiopathic intracranial hypertension patients had significantly lower threshold (6.5 [3.69] vs 8 [1.88], P < .001, 95% CI [-2.250, -0.750]) and threshold-discrimination-identification scores (29.75 [5.56] vs 32.5 [5.25], P = .003, 95% CI [-4.250, -0.750]). Twenty-five patients (57%) were diagnosed with hyposmia. Test scores of patients with active idiopathic intracranial hypertension (n = 18) were not statistically different from patients with inactive disease (n = 26), except for discrimination score (14 [2.50] vs 11 [2.25], P = .005, 95% CI [-3.000, -1.000]). Although idiopathic intracranial hypertension patients with a cerebrospinal fluid opening pressure of ≥330 mmH2 O had lower test scores, the difference was significant only for total threshold-discrimination-identification scores (28.5 [5.50] vs 30.5 [4.38], P = .044, 95% CI [0.750, 5.500]). Multiple regression analysis revealed that test scores were related to disease activity, cerebrospinal fluid opening pressure, papilledema, headache, and medication. CONCLUSION: Our clinical study revealed significant olfactory dysfunction in patients with idiopathic intracranial hypertension compared with healthy controls. Future research should employ larger samples to search for usability of olfactory testing in clinical management of patients with idiopathic intracranial hypertension.

Olfactory dysfunction and quality of life in patients with transfusion-dependent thalassemia.

Transfusion-dependent thalassemia (TDT) is a group of thalassemia syndromes that require regular blood transfusions for survival. It is unknown whether the sense of smell of patients with TDT is affected, and if so, whether smell loss has an adverse effect on quality of life (QOL). Olfactory thresholds were measured using Snap & Sniff® wands. QOL was assessed via the Short Form-36 (SF-36) questionnaire. Forty-two TDT patients from the Thalassemia Center in Istanbul Medical Faculty were tested (mean age 26.6 years), along with 42 healthy controls (mean age 28.0 years). Mean olfactory sensitivity was lower in the TDT patients than the controls (p < 0.0001). TDT was associated with lower mean QOL scores on the domains of physical function (p < 0.0001), physical role limitation (p = 0.011), and general health (p < 0.0001). Within the TDT group, significant correlations were present between the threshold scores and physical function, physical role limitation, emotional role limitation, and general health. Patients with TDT are less sensitive to odors than healthy controls and the lower olfactory test scores are related to lower quality of life, suggesting that decreased smell function is an additional complication of this disease.

Lipoadenoma of the Submandibular Gland.

We report a case of an oncocytic lipoadenoma of the submandibular gland, which is a very rare benign tumor of the salivary gland. The patient was a 36-year-old man with a right submandibular mass measuring 29 × 1.3 × 1.2 cm. When the preoperative diagnostic tools were insufficient to rule out malignancy and for definite diagnosis, total removal of the gland was performed. Histopathologically, microscopic examination revealed a well-circumscribed tumor that is surrounded by a thin, fibrous capsule. The majority of the tumor consisted of adipocytes and normal components of salivary gland tissue. Oncocytic cells were observed only focally. Physicians should keep in mind that salivary glands may rarely exhibit this special tumor growth pattern.

Nasopharyngeal Extension of Giant Meningioma.

Meningiomas are common intracranial neoplasms but extracranial meningioma of the paranasal sinus is extremely rare. The recommended treatment of these meningothelial tumors is complete surgical excision. The authors report a 79-year-old woman presenting with facial pain and nasal obstruction for several months. Endoscopic nasopharyngeal examination showed a right nasal mass that arose from the nasopharynx and reached around the middle meatus. Gadolinium-enhanced magnetic resonance imaging showed a well-circumscribed nasopharyngeal mass, which originates from the right rosenmuller fossa and extends to the right nasal cavity. A biopsy was made with nasal endoscopy under local anesthesia for definitive diagnosis. Histopathologic examination was reported as benign meningothelial meningioma.In conclusion, physicians should keep in mind uncommon tumors in the nasal cavity and paranasal sinuses. Surgical resection is the primary treatment choice; however, close follow-up could be an option in patients with comorbidities.

Breast Cancer Metastasis on the Neck Mimicking a Glomus Tumor.

Cervical metastases from breast carcinoma are extremely rare after several years of disease-free survival. In this article, a metastatic tumor of the neck originating from a breast carcinoma, which has been treated 14 years ago, is discussed. A case is presented of a 48-year-old female patient with a history of breast carcinoma, which was surgically treated approximately 14 years ago. Patient was evaluated as glomus vagale because of clinical and radiologic characteristics. The resection of the mass was performed under general anesthesia, without any complications. The diagnosis of metastatic breast carcinoma was confirmed by histopathologic evaluation. In the differential diagnosis of cervical masses, the cervical metastasis of the breast carcinoma with mimicking clinical presentations should be kept in the mind; especially patients with breast cancer history.

A Rare Complication of Cochlear Implantation After Magnetic Resonance Imaging: Reversion of the Magnet.

Cochlear implants are mechanical devices used for patients with severe sensory-neural hearing loss, which has an inner magnet. It is proven that 1.5 Tesla magnetic resonance imaging (MRI) scanners are safe to use in patients with cochlear implant. In our patient, the authors aim to introduce a rare complication caused after a 1.5 Tesla MRI scanning and the management of this situation; the reversion of the magnet of the implant without displacement and significance of surgery in management.

Surgical Success of Tympanoplasty Using Composite Tragal Cartilage in Chronic Otitis Media.

This study aims to investigate the preoperative, postoperative airway hearing threshold levels, and perforation closure rates in patients who underwent primary tragal cartilage tympanoplasty. One hundred seventy-one patients who had chronic otitis media without cholesteatoma underwent primary tragal cartilage tympanoplasty with endaural approach by using underlay technique. Preoperative and postoperative airway hearing threshold levels at 500, 1000, 2000, 4000 Hz frequencies in 8 to 99 months' follow-up were found and compared with each other. Postoperative perforation closure rates were also investigated. At 500 Hz in 112 patients, at 1000 Hz in 106 patients, at 2000 Hz in 96 patients, and at 4000 Hz in 80 patients, more than 9.5 dB airway hearing gain was determined. The authors found their postoperative perforation closure rate as 84.8%. In conclusion, tragal cartilage tympanoplasty may be chosen as the primary operation technique in primary chronic otitis media patients and by this technique perforation closure rates are also acceptable in addition to satisfactory hearing gain.

Unilateral Inner Mucoperichondrium Flap From Upper Lateral Cartilage and Inferior Mucosal Advancement Flap Technique for Repair of Septal Perforations.

BACKGROUND: Many surgical technique have been described for repair of nasal septal perforations with different success rates. This study aimed to describe authors' surgical technique and discuss its results as well as those reported in the literature. METHODS: Nineteen patients with nasal septal perforation were operated on between March 2009 and February 2015 at Istanbul University, Istanbul Medical Faculty. The technique described in this article, closure of the perforation with unilateral upper lateral cartilage inner mucoperichondrial flap and inferior meatal advancement flap is an alternative surgical technique. RESULTS: Nineteen patients with symptomatic nasal septal perforation were operated with this technique. All surgical procedures were performed by the same surgeon. Neither intraoperative nor postoperative major complications were observed in any patients. Preoperative and postoperative symptom scores for nasal obstruction, epistaxis, nasal discharge, crusting, whistling, snoring, and olfactory loss as well as overall discomfort levels were compared using a visual analog scale. Complete closure of the perforation was achieved in 18 patients (95%). CONCLUSIONS: Small and large perforations may be reliably closed with this technique. Also, this technique can be easily applied via closed or external approach.

The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy.

This study aims to evaluate the effects of voice rehabilitation with indwelling voice prosthesis on quality of life, depression, anxiety, self-esteem, and sexual functions in laryngectomy patients. Provox-1 was applied to 30 patients who underwent total laryngectomy by opening a tracheoesophageal fistula. WHO Quality of Life-BREF, Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self-Esteem Scale, Arizona Sexual Experience Scale forms were asked to be filled out by the patients before voice prosthesis application. These tests were asked to be filled out again 3 months later after the voice prosthesis application. Paired samples and Wilcoxon tests were used to compare before and after operation values. Indwelling voice prosthesis was found to improve quality of life, self-esteem, and sexual function (p < 0.05). Additionally, symptoms of depression and anxiety were regressed (p < 0.05). Indwelling voice prosthesis was found to especially increase the quality of life and decrease depression (p < 0.05). This study is an uncontrolled single-arm study comparing patients' psychosocial statuses pre- and post-voice prosthesis.

Investigation of biomarker in laryngeal carcinomas.

BACKGROUND: The aim of the study is to determine whether there is a role of podoplanin and glutathione S-transferases T1 (GST-T1) expression in laryngeal squamous cell carcinoma. METHODS: In this study, 33 patients were enrolled and gene expression analysis was performed by qRT-PCR. The podoplanin and GST-T1 expression patterns were analyzed to determine their correlation with clinicopathologic parameters of laryngeal cancer. RESULTS: Of all included patients, 20 had supraglottic, and 13 had glottic laryngeal cancer. Increased expression of podoplanin was found in seven (35%) supraglottic tumor tissues and seven (53.8%) glottic tumor tissues, but GST-T1 expression was not detected. CONCLUSION: Podoplanin expression did not show any prediction for tumor differentiation, regional metastasis, thyroid cartilage invasion, lymphatic vessel invasion, or tumor differentiation for laryngeal cancer, and also there were no significant differences in podoplanin expression between glottic and supraglottic regions, but extracapsullar extension is almost statistically significance (P = 0.05).

[Foreign body aspiration: an urgent airway condition]. / Yabanci cisim aspirasyonu: Acil bir havayolu durumu.

OBJECTIVES: This study aims to investigate demographic features, type and localization of foreign bodies, mean hospitalization duration, and peri- and postoperative complication ratios of patients with foreign body aspiration. PATIENTS AND METHODS: Seventy patients (23 males, 47 females; mean age 32±14.5 months; range 3 months to 10 years) who were diagnosed with foreign body aspiration in our clinic between January 2007 and August 2010, and performed rigid bronchoscopy under general anesthesia were included in this study. RESULTS: Main findings were cough, wheezing, and witnessed aspiration. No foreign body was detected in 14 patients (20%). Foreign bodies in 56 patients (80%) were successfully removed. Foreign bodies were located in the left bronchial tree in 23 patients (41%), right bronchial tree in 18 patients (32%), trachea in four patients (7%), bilateral bronchial tree in three patients (5%), carina in two patients (3%), subglottic region in two patients (3%), pyriform sinus in two patients (2%), laryngeal ventricle in one patient (1.7%), and right vocal cord in one patient (1.7%). Foreign bodies were hard-shelled nuts in 23 patients (41%), beans in 14 patients (25%), plastic materials in 11 patients (19%), and other bodies in eight patients (14%). CONCLUSION: Foreign body aspiration is a risky condition particularly for children under the age of four. Bronchoscopy is still the most commonly used and reliable diagnosis and treatment method. Foreign body aspiration should be kept in mind in children with persistent cough, wheezing, and unilateral pulmonary findings in radiologic imaging.

A new transcutaneous bone anchored hearing device - the Baha® Attract System: the first experience in Turkey.

OBJECTIVES: In this study, we reported our experience with a new transcutaneous bone conduction hearing device, the Baha® Attract System. PATIENTS AND METHODS: This multi-center clinical study included the first 12 patients (8 females, 4 males; mean age 27.6 years; range 5 to 65 years) in whom a new transcutaneous bone conduction system was implanted in Turkey. RESULTS: The mean air-bone gap was 41 dB. Bone smoothing around the implant was needed in five patients. We placed a sound processor in the fourth postoperative week for all patients. CONCLUSION: Our study results suggest that the new bone conduction implant is promising for the patients with conductive or mixed hearing loss who are unable to wear conventional air conduction hearing aid and comparable to percutaneous systems.

The use and possible complications of graft materials in rhinoplasty.

Rhinoplasty is indicated for improving nasal breathing, the appearance of the nose, mental well-being and self-confidence. In rhinoplasty, the most important factors are the surgeon's experience and sense of balance and beauty. Facial beauty is related to balance and the symmetry of different parts of the face, including the nose. Balance can be achieved by augmentation or reduction of the various parts of the nose. In rhinoplasty surgery, grafting has become the most widely used technique as well as suture techniques. Currently, grafting is frequently used to support the nasal structure, augment the nose, and correct the nasal contour both in primary and revision rhinoplasty surgery. Therefore, it is expected that surgeon must be comfortable with grafting techniques. Of note, not only the use of suitable surgical techniques, but also the surgeon's experience, patient selection, and regular follow-up influence the success of the procedure.