Cabazitaxel's ototoxicity: An animal study and histopathologic research.

Introduction: Chemotherapeutic agents can have both serious side effects and ototoxicity, which can be caused by direct toxic effects or by metabolic derangement by the agents. Cabazitaxel (CBZ) is a next-generation semi-synthetic taxane derivative that is effective in both preclinical models of human tumors that are sensitive or resistant to chemotherapy and in patients suffering from progressive prostate cancer despite docetaxel treatment. The primary aim of this study is to investigate the ototoxicity of CBZ in a rat model. Materials and Methods: : A total of 24 adult male Wistar-Albino rats were equally and randomly divided into four groups. CBZ (Jevtana, Sanofi-Aventis USA) was intraperitoneally administered to Groups 2, 3, and 4 at doses of 0.5, 1.0, and 1.5 mg/kg/week, respectively, for 4 consecutive weeks; Group 1 received only i.p. saline at the same time. At the end of the study, the animals were sacrificed and their cochlea removed for histopathological examination. Results: : Intraperitoneal administration of CBZ exerted an ototoxic effect on rats, and the histopathological results became worse in a dose-dependent manner (P < 0.05). Conclusion: : Our findings suggest that CBZ may be an ototoxic agent and can damage the cochlea. More clinical studies should be conducted to understand its ototoxicity.

A Role for Mast Cell-Mediated Antibodies in the Formation of Cholesteatoma and Cholesteatoma-Induced Bone Erosion.

The study aimed to evaluate the effects and relationships between mast cells in the matrix, mast cell enzymes tryptase and chymase, epithelial proliferation, microvascular density, and bone destruction in cholesteatoma. Thirty-five biopsies diagnosed with cholesteatoma and seven healthy skin tissues taken from the retro-auricular region for control were evaluated. Immunohistochemical studies were performed with CD117, CD34, Ki-67, chymase, and tryptase antibodies, in a single session for all cases and the control group. The relationship between erosion size and antibody load was determined. The mean cholesteatoma epithelium Ki-67 was higher than the control group (p < 0.001). CD117-positive mast cells, chymase-positive mast cells, tryptase-positive mast cells, and microvessel density were significantly higher in the cholesteatoma matrix compared to the control group (p < 0.002, p < 0.001, p < 0.005). In the group with bone erosion scores of two and above, immunohistochemical markers tended to be higher. A positive correlation was found between CD117 and chymase, tryptase, and microvessel density; between tryptase, chymase, and microvessel density; and between chymase and microvessel density. CD117-positive mast cells and chymase-positive mast cells stimulate angiogenesis, increase the epithelium's proliferative capacity in the cholesteatoma matrix, and form cholesteatoma. The increased proliferation of cholesteatoma epithelium and increased vascular density in the matrix exacerbate bone erosion.

Is the combined use of ultrasonography (USG) and fine needle aspiration biopsy (FNAB) safe in parotis masses? Retrospective comprehensive comparison of 123 cases.

OBJECTIVES: The purpose of the study was to compare final pathology results with ultrasonography (USI) and fine needle aspiration biopsy (FNAB) results in parotis masses. METHODS: A total of 123 patients with primary parotis mass who applied to our center between 2010 and 2020 were selected for the study. Among these, 100 patients with preoperative USI, preoperative FNAB, and postoperative final pathology were included in the study. USI, FNAB, pathology results, surgery types, and demographic characteristics of the patients were analyzed. RESULTS: According to the postoperative final pathology, preoperative USI sensitivity was found to be 100%, specificity was 55, positive predictive value was 84.31%, negative predictive value was 100%, and accuracy was 86.89%. Preoperative FNAB had a sensitivity of 85.7%, a specificity of 92.1%, a positive predictive value of 82.1%, a negative predictive value of 90.2%, and a diagnostic accuracy of 89.3%, according to the postoperative final pathology. CONCLUSION: Preoperative USI and preoperative FNAB are very valuable diagnostic tools in the evaluation of parotis lesions. When used together, they provide highly accurate and important data for the surgeon.

Comparison of the Healing Effect of Nasal Saline Irrigation with Triamcinolone Acetonide Versus Nasal Saline Irrigation alone in COVID-19 Related Olfactory Dysfunction: A Randomized Controlled Study.

There is no routinely determined treatment for olfactory dysfunction because of COVID-19. Saline irrigation and nasal corticosteroid treatments are safe and inexpensive methods, and have low side effects. In our study, we argue that saline nasal irrigation and topical corticosteroid treatment can be used in the treatment of patients with olfactory loss in all areas of rhinology. A total of 150 patients who admitted to our clinic with other symptoms or with only acute odor loss, diagnosed with COVID-19 with RT-PCR were divided into 3 equal groups.Fifty patients in Group 1 were not given any extra treatments. The other 50 patients in Group 2 were given saline irrigation for treatment; and the 50 people in Group 3 were given both saline irrigation and nasal steroid spray for treatment. The "Subjective Olfactory Capability (SOC)" was used for olfactory function evaluation of patients. Self-Rating Olfactory Score (SROS), and Olfactory Dysfunction Duration (ODD) were recorded on the 1st, 15th and 30th days. SROS of the group receiving Nasal Saline + Triamcinolone Acetonide treatment on the 30th day was significantly higher than in other groups ( p -1-3 = 0.018,  p 2-3  = 0.033). Also, the ODD was significantly reduced in this group compared to other groups ( p -1-3  = 0.022,  p 2-3  = 0.028,). Topical triamcinolone treatment was found to be successful in the treatment of olfactory dysfunction due to COVID-19. Nasal steroids, which are both inexpensive and have low side effect profiles, can be used safely in the treatment of patients with olfactory losses.

Rhinoliths: Analysis of 24 Interesting Forgotten Foreign Body Cases.

Rhinoliths are petrified masses formed by accumulation of endogenous or exogenous salts around a nidus. Although rarely formed by the body, the most common cause is foreign bodies forgotten in the nose at childhood. Rhinoliths are rare and have been reported as a single case report in the literature. In this study, 24 different and different cases will be analyzed. Twenty-four interesting patients who were operated for rhinolith in the otorhinolaryngology clinic between 2014 and 2019 and were not seen in the literature before were analyzed retrospectively. The characteristics of these patients such as age, sex, additional pathology, foreign body coexistence, type of anesthesia used, and previous surgical status were analyzed. Fourteen patients were male and 10 were female (58.3% male, 41.7% female). The mean age was 30.4 (minimum 2, maximum 62). Twelve of the foreign bodies were on the right and 12 on the left (50%). Foreign body localization was 13 (54.1%) between the inferior turbinate (IT) and septum and 11 (45.9%) between the middle turbinate and septum. Tissue destruction was seen in 12 (50%; 7 septum, 5 IT) patients. Fifteen patients had additional pathology (mostly septum deviation). General anesthesia was used in 14 patients and local anesthesia was used in 10 (58.3%-41.7%) patients. Two patients (n = 2) had rhinoliths due to forgotten nasal packing after surgery and forgotten silicone nasolacrimal tube after dacryocystorhinostomy surgery. Rhinoliths should be considered with unilateral malodorous runny nose and resistant sinusitis attacks. The diagnosis is rigid endoscope and computed tomography imaging. It usually occurs as a result of forgotten foreign bodies. Rhinoliths may also form as a result of forgotten tampon after previous nose or eye surgery.

An Otalgia Cause: Temporomandibular Joint Herniation From Foramen of Huschke to External Auditory Canal.

OBJECTIVES: The authors presented a rare case of temporomandibular joint hernation into the external auditory canal. The authors discuss 1 cause of otalgia. CASE REPORT: A 52 year old male patient complained about his left ear otalgia for 3 months. Patient said that it had occurred after a painful mastication. On physical examination he had a rounded expanded mass in left ear external auditory canal that is located at the anterior-inferior wall of EAC When patient open his mouth the mass turn back to original position and mass was disappeared. Magnetic resonance imaging of the temporomandibular joint was revealed. CONCLUSION: Foramen of Huschke a bony defect in tympanic plate that may cause the spontaneous herniation of temporomandibular joint to external auditory canal. This herniation cause otalgia commonly. Opening and closing the mouth and palpation of temporomandibuler joint should be a part of physical examination when finding out non-otological causes of otalgia.

Long-term management of patients with PFAPA syndrome.

OBJECTIVE: To evaluate the long-term treatment results of patients with PFAPA syndrome and to determine their need for tonsillectomy. MATERIALS AND METHODS: The clinical characteristics, treatments and long-term results of 16 patients admitted to the Pediatric and Otorhinolaryngology Clinic between 2015 and 2019 were retrospectively analyzed. RESULTS: Twelve male and four female patients were examined between 1.5 and 8 years (mean age 4.8 ± 1.1) (75% male, 25% female). The mean duration of attacks was 4.4 ± 1.4 weeks. Twelve patients recovered completely with single-dose steroid therapy. In the 4-year follow-up of 12 patients who were given a single dose of steroid therapy, there were no relapses. Surgical decisions were made for four patients whose attacks did not pass with steroid treatment. Two patients (75%) underwent adenotonsillectomy, and one patient underwent tonsillectomy While three of these patients did not have an attack again, one patient continued to have an attack every 8 weeks. At the age of 9, his attacks were completely resolved spontaneously. All patients had fever. The most common concomitant symptoms were pharyngitis (94%), cervical adenitis (82%) and aphthous stomatitis (77%). Exudative tonsillitis was present in 25% of the patients. CONCLUSION: Medical treatment should be the first treatment option in patients with PFAPA syndrome. Although single-dose steroid treatment is effective in these patients, tonsillectomy is an important treatment option in refractory cases.

A new and simple test for diagnosis and prognosis in children with otitis media with effusion: cVEMP.

Aim/objectives: A typical vestibular stimulated myogenic potential (VEMP) response depends on suitable sound transfer from the middle ear to inner ear. This transfer is degraded at various degrees in otitis media with effusion (OME). In cases where the effusion is reduced by treating the OME, response to VEMP test can be obtained Backgrounds: In this study we aimed to compare preoperative and postoperative VEMP values of children who were applied ventilation tube for OME and to compare these values and VEMP values of healthy children. Materials and methods: Forty healthy and 40 patients with OME aged between 4 and 16 years were used for the study. VEMP test was performed before and after the surgery. Results: Significant decrease was seen in p13 and n23 values of patient group (p < .05). Statistically significant increase was seen in postoperative amplitudes of patient group (p < .05). Conclusions: Increased VEMP responses in children with OME have shown that dysfunction of middle ear caused vestibular dysfunction. We think that VEMP test can be used to follow up children with OME as a test for showing improvement. Significance: The VEMP test can be used a diagnostic and prognostic test in the diagnosis and follow-up of children with OME.

Total cervical tracheal rupture following blunt trauma.

Tracheal ruptures are rarely seen and potentially high life-threatening injuries. Cervical tracheal injuries occur due to the penetrant trauma rather than the blunt trauma. On the other hand, total cervical tracheal rupture due to the blunt trauma is so rare. A 32 year-old male patient was admitted to the emergency service with complaints of breathlessness and stridor resulting from a traffic accident. Thorax computed tomography of the patient revealed total cervical tracheal rupture under the cricoid cartilage level. Emergency tracheostomy was opened and distal airway safety was provided in operating room. The patient underwent an anastomosis with Collar's incision and was discharged in 16th days postoperatively without any complication other than hoarseness.

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.

Grisel's Syndrome: A Rare Complication following Adenotonsillectomy.

Grisel's syndrome is a nontraumatic atlantoaxial subluxation which is usually secondary of an infection or an inflammation at the head and neck region. It can be observed after surgery of head and neck region. Etiopathogenesis has not been clearly described yet, but increased looseness of paraspinal ligament is thought to be responsible. Patients typically present with painful torticollis. Diagnosis of Grisel's syndrome is largely based on suspicion of the patient who has recently underwent surgery or history of infection in head and neck region. Physical examination and imaging techniques assist in diagnosis. Therefore, clinicians should be aware of acute nontraumatic torticollis after recently applied the head and neck surgery or undergone upper respiratory tract infection. In this paper, a case of an eight-year-old male patient who had Grisel's syndrome after adenotonsillectomy is discussed with review of the literature.

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.

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.

Different navigation of the hypoglossal nerve in the same patient: in the light of the literature.

The hypoglossal nerve appears typically between the internal carotid artery and internal jugular vein and down in the lateral groove between these 2 anatomical structures on to the right common carotid artery bifurcation. In this case report, we presented a patient that was operated on for laryngeal carcinoma, and abnormal navigation of hypoglossal nerve was observed during the neck dissection.