Transmastoid labyrinthectomy for disabling vertigo after cochlear implantation.

OBJECTIVE: To document the use of transmastoid labyrinthectomy in the treatment of disabling vertigo after unilateral cochlear implantation. METHODS: A 58-year-old man with severe-to-profound bilateral sensorineural hearing loss secondary to chronic otitis media underwent cochlear implantation in his right ear with a Pulsar Med-El device. The surgery was uneventful and the electrode was positioned correctly. He had episodic vertigo three months after implant surgery, and medical treatment and aggressive vestibular rehabilitation did not relieve the vertigo attacks. RESULTS: Right transmastoid labyrinthectomy was performed one year after cochlear implantation. The patient's symptoms were immediately relieved, and cochlear implant function was not adversely affected at follow up after three years. CONCLUSION: Transmastoid labyrinthectomy seems to be an effective, safe method for ablating the vestibular end organ after unilateral cochlear implantation.

Facial reanimation with end-to-end hypoglossofacial anastomosis: 20 years' experience.

OBJECTIVE: This study aimed to evaluate retrospectively the results of experience with end-to-end anastomosis of cranial nerves VII and XII, performed due to transection of the facial nerve during acoustic neuroma removal. METHODS: We assessed the facial reanimation results of 33 patients whose facial nerves had been transected during acoustic neuroma excision via a retrosigmoid approach, between 1985 and 2006, and who underwent end-to-end hypoglossofacial anastomosis. We compared the facial nerve functions of patients receiving short term (two to three years) and long term (more than three years) follow up, and we assessed any complications of the anastomosis. RESULTS: A House-Brackmann grade III facial function was achieved in 46.2 and 86.4 per cent of the patients in the short and long term, respectively. House-Brackmann grade IV facial function was achieved in 53.8 and 13.6 per cent of the patients in the short and long term, respectively. There was a statistically significant difference between the facial recovery results, comparing the short and long term follow-up periods (p = 0.03). Disarticulation was the most common complication, seen in 19 (57.6 per cent) patients; numbness of the tongue was the next commonest (10 (30.3 per cent) patients). None of the patients developed dysphagia. CONCLUSION: Despite such morbidities as disarticulation and tongue numbness, end-to-end hypoglossofacial anastomosis is still an effective procedure for the surgical rehabilitation of static and dynamic facial nerve functions. Significant improvement in facial nerve function can occur more than three years post-operatively.

Congenital neck masses in children and their embryologic and clinical features.

Congenital neck masses in children and their embryologic and clinical features. Neck masses of congenital origin can be diagnostic and therapeutic challenges for internists, paediatricians and surgeons. Treatment modalities of congenital neck masses are different depending on their nature, symptoms and location. Differential diagnosis includes a variety of diseases that can cause cervical masses such as infectious and neoplastic neck tumours. Our objective is to review the embryologic and clinical features of some of the most common congenital neck masses such as the haemangioma, branchial cleft anomalies, thyroglossal duct cyst, ectopic thyroid, congenital midline cervical cleft, congenital cervical teratoma, lymphangioma, cervical thymic cyst, dermoid cyst and congenital muscular torticollis.

Absence of contralateral suppression of transiently evoked otoacoustic emissions in fibromyalgia syndrome.

OBJECTIVE: To assess contralateral suppression of transiently evoked otoacoustic emissions in patients with fibromyalgia syndrome and normal hearing. METHODS: Twenty-four female patients with fibromyalgia syndrome and 24 healthy female controls with normal hearing were assessed using pure tone audiometry and transiently evoked otoacoustic emissions. RESULTS: All patients with fibromyalgia syndrome and all controls had normal hearing on pure tone audiometry. In the patients with fibromyalgia syndrome, the mean transiently evoked otoacoustic emission amplitude was 15.5 +/- 4.8 dB. The mean transiently evoked otoacoustic emission amplitudes after contralateral suppression was 15.5 +/- 4.9 dB. There was no statistically significant difference between the transiently evoked otoacoustic emission amplitudes measured before and after contralateral suppression (p > 0.05). In the controls, the mean transiently evoked otoacoustic emission amplitude was 12 +/- 5 dB. The mean transiently evoked otoacoustic emission amplitudes after contralateral suppression was 11 +/- 4.7 dB. There was a statistically significant decrease in transiently evoked otoacoustic emission amplitudes after contralateral suppression (p < 0.01). CONCLUSION: The mechanisms related to contralateral suppression of transiently evoked otoacoustic emissions seem dysfunctional in fibromyalgia syndrome. This dysfunction may be at the brain stem level, where the medial superior olivary complex is located, or at the synapses of medial superior olivary complex fibres with the outer hair cells in the cochlea. Demonstration of lack of contralateral suppression of transiently evoked otoacoustic emissions can be used as a diagnostic tool in patients with fibromyalgia syndrome.

Assessment of the ear and otoacoustic emission findings in fibromyalgia syndrome.

OBJECTIVE: We aimed to assess otoacoustic emission (OAE) findings in fibromyalgia (FM) syndrome. METHODS: Thirty-two ears of 16 female patients with FM syndrome and 30 ears of 15 healthy female controls were also included in the study. Pure tone audiometry, speech discrimination testing, tympanometry and otoacoustic emission testing (both transiently evoked and distortion product) were performed. RESULTS: There was no significant difference between the pure tone hearing results of the patients and controls (p > 0.05). There was no significant difference between the distortion-product-otoacoustic emission results of the patients and controls. Audiologic findings of the patients with and without otologic symptoms were not significantly different than controls (p > 0.05). CONCLUSION: Although FM patients generally have subjective symptoms related to ear, clinical or laboratory assessments usually fail to find out any objective finding related to these subjective symptoms. The otologic functions seem spared in FM syndrome.

Assessment of mastoid air cell size versus sigmoid sinus variables with a tomography-assisted digital image processing program and morphometry.

We assessed the mastoid air cell size and variables of the sigmoid sinus in healthy ears and ears with chronic otitis media (COM). Thirty-eight patients with unilateral COM [15 with cholesteatoma (COM/+) and 23 without cholesteatoma (COM/-)], and 20 subjects with healthy ears, were included in the study. Assessment was performed using a quantitative digital image processing computed tomography (CT) program, and the volume of the mastoid bone was measured using the morphometric method of Cavalieri. In both COM/+ and COM/- patients the sigmoid to suprameatal spine distance and mastoid size were greater on the healthy side than on the diseased side ( p<0.05). The distance and area were significantly greater in the healthy control subjects than in either the healthy or the diseased ears of the patients with COM ( p<0.05). In the healthy ears of COM patients, there was significant correlation between the sigmoid to suprameatal spine distance and air cell size and mastoid volume ( p<0.05). In the diseased ears of COM patients, this correlation was absent ( p>0.05). The sigmoid sinus shape was of the half-moon type (62%), protrusive type (22%) and saucer type (16%). The digital image processing CT program allowed us to estimate the individual area of the air and soft tissue filled mastoid air cells. The mastoid size in both intact and disease ears of COM patients was smaller than in the healthy controls. The mastoid size may be determined genetically. However, environmental factors such as infection may also affect the mastoid size. Therefore, both genetic and environmental factors may be related to COM as far as the size of the mastoid air cells is concerned.

Körner's septum (petrosquamosal lamina) and chronic ear disease.

To assess the clinical significance of Körner's septum (KS) or petrosquamosal (PS) lamina in different chronic ear pathologies, a surgical and anatomic study was carried out, in which the significance of KS was assessed in various otologic diseases. Of 639 patients who underwent ear surgery between 1998 and 2001, 426 were included in the study. The diagnoses were chronic otitis media without cholesteatoma (COM), tympanosclerosis (TS), adhesive otitis media (AOM) and cholesteatoma (COL) in 160, 100, 70 and 96 patients respectively. The operative records of the patients were reviewed for the presence of KS. There was antral blockage by KS in all patients who also had Cog (the middle portion of the PS lamina). KS was mostly seen in cases of TS. The prevalence of KS was not significantly different when the result of the COM group was compared with that of the COL and AOM groups ( p>0.05). The prevalence of KS was significantly higher in patients with TS than in those with COM. Both antral and epitympanic blockages were more prevalent in cases of TS than in those of COM (chi(2) =3.9, p =0.04 and chi(2) =6.6, p =0.01 respectively). There is a significant association between the presence of KS and TS. Based on this finding, it is recommended that a mastoidectomy be performed in cases of severe tympanosclerosis in order to remove KS. How the removal of this anatomic impact will affect the natural course of the disease is still a question that needs further investigation.

Important anatomic variations of the sinonasal anatomy in light of endoscopic surgery: a pictorial review.

Advances in surgical techniques and instrumentations, utilization of the imaging tools, and understanding the regional anatomy have served to make functional operations with less complications in the paranasal sinus area. In the context of this article, some of these anatomical structures and their variations were reviewed through images. These structures were as follows: course of the anterior ethmoidal artery; roof of the ethmoid; lamina papyracea; uncinate process; optic nerve; and internal carotid artery.

Cycline-dependent kinase inhibitor, p27 (KIP1), is associated with cholesteatoma.

OBJECTIVE: Cyclin-dependent kinases (CDKis) can arrest the cell cycle, which in turn inhibits the cell proliferation. P27 (KIP1) is a CDKi and acts as a tumor suppressor gene. In this study, we aimed to investigate the role of p27 CDKi in cholesteatoma, a disease characterized by the presence of hyperproliferative squamous epithelium. STUDY DESIGN: Immunohistochemical staining of 15 cholesteatoma and 18 control ear canal skin samples, which were taken intraoperatively, was performed for p27 positivity. METHODS: The monoclonal antibodies to p27 were used for immunohistochemical staining of the sections. The streptavidin-biotin horseradish method was used. The number of cells staining positive for p27 was calculated, and the intensity of p27 positivity was graded. RESULTS: P27 positivity was obtained in 9 (50%) of 18 skin tissues. In the cholesteatoma tissues, p27 positivity was found only in 2 (13.3%) tissue samples. The difference between the groups were statistically significant (P =.03). The mean numbers of p27 positivity were 11.8 +/- 15.5 and 1.4 +/- 3.8 (mean +/- standard deviation) in the skin and cholesteatoma samples, respectively. This difference was also statistically significant (P =.02). The p27 results of primary and secondary cholesteatoma samples were not significantly different (P =.3). The results of p27 were not related to the gender of the patients (P =.8). CONCLUSION: P27 is involved directly or indirectly in the occurrence of cholesteatoma. Alterations of p27 levels in keratinocytes can influence the proliferative state of the keratinocytes. Altered p27 levels in cholesteatoma may suggest a molecular pathology in cholesteatoma. The search for significance of CDKis seems promising to better understand the pathogenesis of cholesteatoma.

Malignant mixed tumor of the larynx: a case report.

Malignant mixed tumour (MMT), which is a salivary gland tumour, is the malignant form of pleomorphic adenoma. Although the tumour can also originate from the minor salivary glands throughout the submucosa in the head and neck region, laryngeal involvement is quite rare. An additional case of laryngeal MMT presented in a forty-five year old man, and the diagnostic, immunohistochemical (S-100, actin, vimentin, epithelial membrane antigen) and therapeutic procedures were presented.

Variations of sphenoid and related structures.

The aim of this study was to delineate the precise relationship between the sphenoid sinus and internal carotid artery and the optic nerve, as well as to assess incidence of the anatomic variations of these structures. A review of 92 paranasal sinus tomographic scans was made for anatomic variations of the sphenoid sinus and related bony and neurovascular structures. Coronal and axial tomographic sections were obtained with 2.5-mm section thickness. We assessed the protrusion of the internal carotid artery (ICA) and the optic nerve (ON) into the sphenoid sinus, bone dehiscence of these structures, and pneumatization of the anterior clinoid process (ACP) and pterygoid recess (PR), as well as the variations of the sphenoid sinus septum. The protrusion of the ICA into the sphenoid sinus was found in 24 (26.1%) patients. An ON protrusion was present in 29 (31.5%) patients. Pneumatization of the PR was encountered in 27 (29.3%) patients. There was not a statistically significant relationship between the pneumatization of the PR and ICA protrusion into the sphenoid sinus (chi2 = 0.258, p = 0.168). A significant relationship between the ACP pneumatization and protrusion of the ON into the sphenoid sinus was found (chi2= 0.481,p = 0.007). Preoperative recognition of the anatomic variations by the radiologist is beneficial for identification of the limits of dissection. This is particularly important in the sphenoid sinus area where extensive pneumatization of the skull base bones may distort the anatomic configuration. Therefore, axial and coronal CT sections should always be obtained prior to any surgery in the sphenoid sinus area.