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.

A New Biomarker in Differentiation of Mucosal Chronic Otitis Media from Squamous Chronic Otitis Media: The Systemic Immune-Inflammation Index (SII).

The Systemic Immune-inflammation Index (SII) is a new biomarker based on the number of neutrophils, platelets, and lymphocytes in the Complete blood count, and is shown as diagnostic and prognostic in many diseases. Mucosal or Squamous COM differentiation is necessary preoperatively in chronic otitis media patients. The purpose of this study was to test the predictive value of inflammation markers to predict the differentiation of Mucosal COM and Squamous COM. Our aim is; using "SII" as a powerful test to differentiate cholesteatoma and active mucosal middle ear disease. In the present study, 300 patients who underwent mastoidectomy ± tympanoplasty between 2010 and 2020 were retrospectively evaluated. The patients were divided into two equal groups as clinical, microscopically, and pathologically Squamosal COM (Cholesteatoma) and Mucosal COM (Suppurative) (n = 150). Routine hemogram tests were performed for both groups. White blood cell, red blood cell, neutrophil, lymphocyte, and platelet numbers were calculated. The SII value was calculated manually according to the formula of "neutrophil × platelet/lymphocyte. There were a total of 300 patients who were aged 20-63 in both groups. A total of 130 of these patients were male (43%), and 170 (57%) were female. In terms of NLR and PLR, Group 2 (Mucosal COM) had higher values at statistically significant levels (p < 0.001, p < 0.001, respectively). In terms of SII, Group 2 (Mucosal COM) had higher values at statistically significant levels (p < 0.001). According to the results of the ROC Analysis in our series, it was found that NLR, PLR, and SII values were above the acceptable level, and were statistically significant (p < 0.001, p < 0.001, p < 0.001, respectively). The cut-off value of SII was 470.29, sensitivity was 65.8, and specificity was 34. According to our study, high SII values in COM differentiation are very important in diagnosing Mucosal COM. SII values can help to the diagnosis in Squamous COM/Mucosal COM differentiation. There is no current practical, inexpensive, and widespread laboratory test used in the Mucosal/Squamous COM differentiation. SII can be diagnostic, and determine the treatment in this differentiation. A great number of studies are needed for SII values to become standard in COM.

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.

Congenital Deficiency of Alar Cartilage.

ABSTRACT: Alar cartilage anatomically determines the size, position, and shape of the nose type. It is also effective in the respiratory function of the nose. The structure of alar cartilage differs from person to person. Congenital anomalies of the nose due to absence of alar cartilage are extremely rare. Usually, trauma and infections are blamed for etiology. The absence of nasal alar cartilage causes both aesthetically nasal deformities and respiratory dysfunction problems. In the literature, congenital alar cartilage defect has been reported as cases with a substantial partial defect. In this study, it is aimed to present a case with unilateral, isolated, complete alar cartilage absence detected in a patient who underwent septorhinoplasty, and with the treatment approach applied in light of current literature knowledge.

New Approach for Endoscopic Endonasal Transsphenoidal Pituitary Surgery: Modified Nasoseptal Rescue Flap.

INTRODUCTION: Endoscopic endonasal approach has become popularly preferred for pituitary surgery in recent years. In this study we described a new technique which is developed by the first author and which is modified from The Rivera-Serrano "salvage" flap approach. With this new technique the septum morbidity was completely prevented and a wider and more comfortable vision was provided for the operation. MATERIALMETHOD: This study consists 7 patients who underwent endoscopic endonasal transsphenoidal pituitary surgery (EETPS) with the described technique (modified salvage flap technique) between 2017 and 2019 and 13 patients underwent EETPS using salvage flap technique. The follow-up period was at least 6 months (24-6 months) for septal integrity. RESULTS: Intraoperative septum integrity was observed in all 7 patients who were treated with modified rescue flap technique. In 9 of 13 patients who had salvage flap technique, intraoperative septum posterior defects were observed. In postoperative follow-up (min postop 3 months), endoscopic examination showed no septal perforation in 6 patients who were treated with modified rescue flap technique, and 1 patient had 2 × 2 mm perforation posteriorly. In postoperative endoscopic follow-up of 13 patients who underwent salvage flap technique (min postop 3 months), 4 patients had complete septal integrity, while 9 patients had different sizes of posterior septal perforation. CONCLUSION: According to other described approach techniques, our modification using a pedicle and septum protective-transposition technique provides improved access to the downstream side of the sphenoid sinus and clivus, allowing the pedicle to slide down and take a more horizontal position. The improved maneuverability of the pedicle created in the case of cerebrospinal fluid leakage as a complication also allows it to be used as a bilateral wing to cover the exposed bone. We think that this technique is the best method to be used for EETPS with modified saline flap technique.

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.

Broad, Recurrent Nasal Dermoid Cyst: A Challenging Task.

Nasal dermoid sinus cyst is a rare congenital midline anomaly. The embryological origin is different from the dermoid cysts seen in other parts of the face. Nasal dermoid sinus cysts constitute 1% to 3% of all dermoid cysts and 11% to 12% of head and neck dermoid cysts. While most lesions are detected in the first 3 years, in some cases they may not be noticed until later years. Delay in diagnosis increases recurrent infections, airway obstruction and intracranial complications. The authors present a 34-year-old patient with a broad nasal dermoid cyst who had previously undergone external rhinoplasty for a nasal dermoid cyst but relapsed after 5 months.

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.