Temperature rises in the round window caused by various light sources during insertion of rigid endoscopes: an experimental animal study.

OBJECTIVES: The instruments used in endoscopic surgery include rigid endoscopes of different diameters and angles, sources of light and monitors. In this study, we explored temperature rises in the round window caused by insertion of rigid endoscopes of different diameters into the middle ear; the endoscopes were fitted with different light sources. DESIGN: An experimental animal study. SETTING: We subjected seven guinea pigs to simulate otological surgery at room temperature. We monitored body temperatures, along with temperature rises caused by the use of 0° rigid endoscopes of diameters 3 or 4 mm, fitted with light sources including a halogen light, a light-emitting diode (LED) and a xenon light. Data were collected every second from a sensor placed in the round window. PARTICIPANTS: An experimental study on 7 guinea pigs. MAIN OUTCOME MEASURES: Rise of the temperature on round window. RESULTS: Rigid endoscopes caused the temperature of the tympanum to rise when xenon and halogen light sources were used, regardless of endoscope diameter. However, the temperature rise was less when a LED light source was employed. CONCLUSION: The endoscopic instruments used in middle ear surgery caused the temperature of the round window to rise. The rise varied with endoscope diameter and the type of light source used.

The importance of Epley maneuver in posterior canal benign paroxysmal positional vertigo.

OBJECTIVE: We investigated symptom scores and quality of life in unilateral posterior canal benign paroxysmal positional vertigo (BPPV) patients. PATIENTS AND METHODS: In this retrospective and multicentric study, 78 patients with unilateral posterior canal BPPV (47 right-sided and 31 left-sided) were included. All patients have performed the Standard Epley maneuver. Features of the nystagmus [nystagmus duration (second), latent period (second)] and features of the disease [side (right or left-sided), disease duration (years), and recurrence of disease (present or absent)] were noted. Before and 1 week after the Epley maneuver, all patients were evaluated using the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), and Vertigo Dizziness Imbalance health-related quality of life scale (VDI-HQoL). RESULTS: Our results showed that VSSs of the right-sided group were significantly higher than those in the left-sided group before and 1 week after the maneuver (p<0.05). One week after the maneuver, VDI-HQoLs of the left-sided group were significantly higher than those in the right-sided group (p<0.05). In all right-sided and left-sided groups, at 1 week after the maneuver, VSSs were significantly lower, and VDI-SSs and VDI-HQoLs were significantly higher than those before the maneuver (p<0.05). As VSS values increased, VDI-SS and VDI-HQoL values decreased (p<0.05). In the left-sided group, VSS values decreased, and VDI-HQoL values increased. As disease duration increased, VSS values increased before the maneuver (p<0.05). In females, VSS values increased, and VDI-SS and VDI-HQoL values decreased before the maneuver (p<0.05). CONCLUSIONS: In posterior canal BPPV, the Epley maneuver effectively decreased VSS values and increased VDI-SS and VDI-HQoL values. In the left-sided BPPV group, there were lower VSS values and higher VDI-HQoL values that showed better quality of life of the patients. Older age and female gender are other factors related to lower quality of life with higher symptom scores.

The comparison of 1-year results for mini and wide-size cap grafts applied to nasal tips.

OBJECTIVE: In the present study, we evaluated patient satisfaction with cap grafts by Rhinoplasty Outcomes Evaluation (ROE) scores. Mini cap and wide cap grafts were applied. PATIENTS AND METHODS: A total of 80 patients who underwent a rhinoplasty operation with cap graft application to the tip region were included in the study. According to the cap graft size, there were two groups: Group 1 consisted of 40 patients with cap graft size ≤7 cm (mini cap group). Group 2 comprised 40 patients with cap grafts ≥8 cm (wide cap group). Patients in groups 1 and 2 underwent evaluations based on the following criteria at preoperative, postoperative-1st month, and postoperative-1st year intervals: (1) Rhinoplasty Outcomes Evaluation Questionnaire (ROE), (2) tip projection (cm), (3) nasal dorsum length (cm), (4) tip projection ratio (Goode), (5) nasofrontal angle, and (6) nasolabial angle. RESULTS: Postoperative 1st-month and 1st-year ROE scores of the wide cap group were significantly higher than those in the mini cap group (p<0.05). Preoperative tip projection ratio (Goode) values of the wide cap group were considerably higher than those in the mini cap group (p<0.05). There were no significant differences between tip projection, nasal dorsum length, nasofrontal angle, and nasolabial angle values of the mini cap and wide cap groups (p>0.05). Correlation tests showed that as preoperative ROE scores decreased, postoperative-1st month and 1st-year ROE scores increased (p<0.05). Postoperative 1st-month and postoperative 1st-year's ROE scores increased together (p<0.05). In the wide cap group, postoperative 1st-month and postoperative 1st-year's ROE scores increased compared to the mini cap group (p<0.05). As postoperative 1st-year nasolabial angle values increased, postoperative 1st-year ROE scores also increased (p<0.05). CONCLUSIONS: We found that patients who received wide-cap rhinoplasty had increased postoperative ROE scores and higher satisfaction rates during the first month and first year. Postoperative higher nasolabial angle values were related to higher ROE scores and patient satisfaction in the postoperative 1st year.

A new preservation technique for dehumping the dorsum.

OBJECTIVE: We aimed to offer a new preservation strategy for dehumping the dorsum by using a variation of the cartilage push-down (Ishida) technique. PATIENTS AND METHODS: Three hundred patients (42 males and 258 females) had surgical procedures. All procedures were closed-surgery-type, primary-case procedures performed through a closed incision. Low cartilaginous septal strip resection was performed on 269 individuals, whereas high septal strip resection was performed on the remaining 31 patients. The bony cap is shielded as a separate unit and preserved, so protected from any potential damage. The cartilage roof is separated from the bone roof and lowered while wearing the bony cap component. As a result, less concealment is required. However, it is ineffective on dorsal profiles that are sharp or S-shaped, as opposed to flat. Thus, the modified cartilage push-down with bony cap rasping procedure can be carried out. The sharp hump on the bony crown of the skull is smoothed out and filled. Therefore, the bony cap above the central cartilage roof is much thinner. Because the hump is less likely to appear again, concealment is unnecessary. A median of 8.5 months was spent following-up (6-14 months). RESULTS: According to our method, among men (n=42), the hump size ranged from minor (n=5) to medium (n=25) to big (n=12). There were 258 women, 88 of whom had a little hump, 160 had a medium hump, and 10 had a huge hump. Indicative of surgeon satisfaction with low cartilaginous septal strip excision vs. high septal strip resection include the following: with a total of 269 patients, 35 males, and 234 females had low cartilaginous septal strip resections, with 98 and 96% success rates, respectively, for the surgeons. There were 31 patients, seven men and 24 women, who all underwent high septal strip resections, with a 98% and 96% success rate for the surgeons. It was found that there was a correlation between the size of the hump and the level of satisfaction felt by its bearers. Rates of male satisfaction with humps ranged from 100% for little humps to 100% for medium humps to 99% for huge humps. Satisfaction percentages among women ranged from 98% in the case of little humps to 96% among medium humps and 95% among large humps. CONCLUSIONS: Our technique of modification of the cartilage push-down (Ishida)1 method is applied for dehumping the dorsum. High satisfaction percentages were obtained from the patients and surgeons. This technique may be a good option for patients who need dehumping.

A new approach for cerumenolytic treatment in children: In vivo and in vitro study.

OBJECTIVES: To demonstrate the effects of various cerumenolytic solutions in vivo and in vitro and to measure the change in pain following treatment. METHODS: The study was done as a single-centre, prospective and double-blind study. Among 1243 paediatric patients with total or nearly total occlusive plug in 4 years period, those who accepted endoscopic ear examination and cleaning via aspiration after a follow-up period of at least 10 days following treatment were included in the study. Day of total TM visualisation was noted and removal co-efficient was calculated. The pre and post-treatment pain levels of the patients were assessed using analogue chromatic continuous scale (ACCS). In the in vitro part, cerumen samples collected at equal amounts from 20 patients were treated at 36-400°C in 6 different tubes with the same solutions and their dissolution degrees were assessed over a period of 5 days (Hour 6, Hour 12, Hour 48, Hour 72, Hour 92, Hour 120). Additionally, the degree of resolution in the tube treated with distilled water was considered to be the control reference. RESULTS: In the in vivo part of the study, total TM visualisation was observed in Group 1 at 50.2% (Day 3), in Group at 57.1%, in Group at 62.3%, in Group at 44.3% and in Group 5 at 73.5%. The group with the lowest removal co-efficient was Group 5 (removal co-efficient=1.623). In reference to the ACCS pain scores of the patients, the intra-group change pre-post treatment was found statistically significant for all groups (p=0.008; p=0.0222; p=0.005; p=0.026; p=0.018). After statistical analysis between the groups the difference between Group 5 and other groups was found statistically significant (p=0.002; p=0.026; p=0.044; p=0.034). In the in vitro part of the study, the best dissolution was observed in Group 2. CONCLUSIONS: In our study, the best cerumenolytic solutions were identified to be glycerine 10cc+3% hydrogen peroxide 10cc+10% sodium bicarbonate 10cc+distilled water 10cc. Especially the use of this mixture ease in terms of pain for the patient and in terms of time and comfort for the physician during the removal procedure.

Histological analysis of the effects of anti-adhesive haemostatic agents on the middle ear of the guinea pig.

INTRODUCTION: Adhesion formation is a frequent and serious post-operative problem in ENT surgery. This study assessed the effect of two anti-adhesive haemostatic agents on an experimental guinea pig model. MATERIALS AND METHODS: The middle-ear mucosa of 14 guinea pigs was exposed to surgical trauma. After surgery, Arista™ AH was injected into the right middle ear of seven animals, while Ankaferd Blood Stopper was injected into the right middle ear of the other seven animals. The left ears were left untreated and regarded as the control group. The three groups were compared by histological examination at post-operative week 4. RESULTS: In each of the three groups, consolidation of the lamina propria and epithelium mucosae, increments in the number of active fibroblasts, collagen fibrils and inflammatory cells, and increased vascular dilation were observed on haematoxylin and eosin-stained sections, and were more prominent in the control and Ankaferd Blood Stopper groups. Epithelial thickness and capillary vasodilation were significantly lower in the Arista™ AH group compared with the control and Ankaferd Blood Stopper groups (p < 0.008). CONCLUSION: Arista™ AH may prevent the formation of adhesions in middle-ear surgery. Further experimental studies are required to determine its ototoxic potential.