The effects of different environmental pH on healing of tympanic membrane: an experimental study.

In this study, we investigated the effect of environmental pH on healing of acute rat tympanic membrane perforations. Twenty Wistar albino rats were divided into four groups and used in the study. A large myringotomy was performed in the posteroinferior quadrants of both tympanic membranes. In left ears, topical pH 4 standard calibration solution was used in groups 1 and 3, and pH 7 standard calibration solution was used in groups 2 and 4. Right ears served as controls, and allowed for spontaneous healing. The solutions were applied for 2 days in groups 1 and 2, and for 7 days in groups 3 and 4. Healing was assessed by macroscopic closure of the tympanic membrane perforation, and histopathological analysis of lamina propria edema, neovascularization, inflammatory cells, and fibroblastic reaction in the temporal bones. pH 7 and pH 4 groups were similar for macroscopic closure of perforation on day 2; however difference was significant on day 7. The fibroblastic activity was significantly less on days 2 and 7 in pH 4 group. On day 7, there were significant differences between pH 4 and pH 7, and pH 7 and control groups for inflammatory cell infiltration. In conclusion, clinical and histopathological results of this study indicated that acidic environmental pH speeded up and shortened wound-healing process. By building up optimum environmental pH, a healthy healing may be achieved in acute tympanic membrane perforations.

Correlation Between the Septal Body and the Nasal Turbinates in Patients With Deviated Nasal Septum.

OBJECTIVE: The purpose of this study was to evaluate the degree of deviation and the sizes of nasal turbinates and the septal body (SB) on each side separately and to compare the 2 sides, and to evaluate if there is a correlation between SB size and middle and inferior turbinate (IT) sizes on each side. MATERIAL AND METHODS: A retrospective analysis was made of paranasal computerized tomography scans obtained randomly from the database. Computerized tomography was performed at 120 kVp and 100 mA with 2 mm slice thickness. The study comprised 199 paranasal computerized tomography scans on each of which the width of the SB, the degree of deviation, and the width of the inferior and middle turbinates (MTs) were measured on each side separately. RESULTS: In cases of moderate and severe deviation, the sizes of the SB, the MT, and IT contralateral to the deviation were statistically significantly larger than those on the ipsilateral side (P < 0.001). There was a negative correlation between SB size and the MT and IT sizes in each nasal cavity. CONCLUSIONS: The SB is a dynamic structure and may play a role in regulation of nasal airflow.

Is Allergic Rhinitis a Factor That Affects Success of Tympanoplasty?

OBJECTIVE: The aim of the present study was to investigate the effect of allergic rhinitis on the success of the operation in chronic otitis surgery by using score for allergic rhinitis (SFAR). MATERIALS AND METHODS: In the present study; 121 patients, who underwent type 1 tympanoplasty were examined retrospectively. SFAR of all patients were recorded. The graft success rates of 26 patients with allergic rhinitis (AR) and 95 patients with no allergic rhinitis group (NAR) were compared. RESULTS: While the graft success rate in NAR group was 89.5%, this rate was 80.8% in the AR group. However, the difference between groups was not statistically significant (p = 0.311). CONCLUSION: These findings suggest that allergic rhinitis decreases the graft success rate of the pathologies occurring in eustachian tube, middle ear and mastoid although statistically significant difference wasn't found. Prospective studies with larger patient groups are required in order to evaluate this pathology.

An objective analysis of sebum, pH and moisture levels of the external ear canal skin.

OBJECTIVE: To determine sebum, pH and moisture levels of external ear canal skin, and compare the patients who complain of ear itching and the normal population for these parameters. And evaluate the improvement subjectively in the ones given dexamethasone sodium phosphate (DSP) cream or placebo-water in oil emulsion type cream, and to determine the changes in sebum, pH and moisture levels after the treatment. METHODS: 32 females with the complaint of isolated external ear canal itching and 42 healthy women were included in this randomized prospective controlled study. The sebum, pH and moisture levels of ear skin of the patients and the controls were determined from baseline and following treatment. Patients used DSP in their right and the placebo in their left ears for 15 days. Subjective analysis of itching level was measured at baseline, and on 15th and 30th days using visual analog scale (VAS). RESULTS: There was no statistically significant difference between pretreatment and post-treatment pH and sebum levels of the study group and the control group. However, pretreatment and post-treatment moisture levels of the study group were significantly higher (p<0.001). CONCLUSION: The study found an association of increased moisture levels of the external ear canal skin and isolated ear itching.

Does glubran 2 improve the graft uptake in tympanoplasty? A retrospective study.

Tympanoplasty is a common procedure in otolaryngology practice and several factors have been described to increase graft uptake. Independent of the technique and graft material, the revascularization process of the graft is related to patient factors as well as contact of the tympanic membrane remnant's edges with the graft material. A number of different tissue glue materials and other packing methods have been used for graft stabilization. Glubran 2, a cyanoacrylate containing surgical tissue adhesive, has highly effective anticoagulant and adhesive properties, and the present study aims to reveal the effectiveness of this glue on tympanoplasty surgery. The study is designed as retrospective chart review and it was set up at Etlik Ihtisas Research and Training Hospital which is a tertiary care center. The study population consisted of 68 consecutive patients aged between 9 and 75 years who underwent over-underlay tympanoplasty. The patients were divided into two groups according to use of glubran 2 as a sealing material for graft fixation. The patients in whom glubran 2 was not used served as the control group. There were 20 women and 16 men in the glubran 2 group, 17 women and 15 men in the control group. These two groups were also subdivided into two groups for the graft type used (temporal muscle fascia or tragal cartilage). The overall graft take rate was 88.9 % in the tympanoplasty group sealed with glubran 2 and 84.4 % in the control group. A statistically significant decrease was seen in hearing thresholds in both groups postoperatively when compared to the preoperative values (p < 0.001 for both). There was no significant otorrhea in either group. Graft uptake and hearing recovery were similar in glubran 2 and control groups. These findings suggest that glubran 2 is an effective material for fixation of the graft in tympanoplasty, but it does not have a notable effect on the success of the surgery.

Reinke Edema: Watch For Vocal Fold Cysts.

Reinke edema is one of the common cause of dysphonia middle-aged population, and severe thickening of vocal folds require surgical treatment. Smoking plays a major role on etiology. Vocal fold cysts are also benign lesions and vocal trauma blamed for acquired cysts. We would like to present 3 cases with vocal fold cyst related with Reinke edema. First case had a subepidermal epidermoid cyst with Reinke edema, which could be easily observed before surgery during laryngostroboscopy. Second case had a mucous retention cyst into the edematous Reinke tissue, which was detected during surgical intervention, and third case had a epidermoid cyst that occurred 2 months after before microlaryngeal operation regarding Reinke edema reduction. These 3 cases revealed that surgical management of Reinke edema needs a careful dissection and close follow-up after surgery for presence of vocal fold cysts.

Comparison of temporal muscle fascia and cartilage grafts in pediatric tympanoplasties.

OBJECTIVE: To compare anatomic and functional outcomes of the different graft materials used in pediatric tympanoplasty. MATERIALS AND METHODS: The patients younger than 18 years of age and who had tympanoplasty between 2010 and 2012 were included in the study. Temporal muscle fascia or cartilage was used as the graft material. The age, gender, the side of the operated ear, the operation technique, pre- and postoperative audiological results, and the status of the graft were noted. An intact graft and an air-bone gap (ABG) ≤ 20 were regarded as surgical success in the postoperative period. Audiograms obtained before surgery and 1 year after surgery were used for the comparison. RESULTS: Sixty pediatric cases were included in the study. Fascia graft was used as the graft material in 35 of them, and cartilage was used in 25 patients. The graft success rate was 82.9% in the fascia group while it was 92% in the cartilage group. In the fascia group preoperative ABG was 28.2 ± 10.1 dB, postoperative ABG was 15.1 ± 10.2dB, and postoperative gain was 13.1 ± 9.6 dB. In the cartilage group, preoperative ABG was 28.9 ± 10.2dB, and postoperative ABG was 16.8 ± 10.3 dB with a postoperative gain of 12.1 ± 6.8 dB. The differences between the fascia and the cartilage groups were not statistically significant either for hearing gain or graft success rate. CONCLUSION: Cartilage and fascia grafts yield similar results for hearing gain and graft success rate in pediatric tympanoplasty.

The effects of nasal base stabilization techniques on nasal tip rigidity.

BACKGROUND: The aim of this study was to compare the degree of nasal tip rigidity from different techniques for increasing nasal tip projection. METHODS: Retrospective records of patients who had undergone rhinoplasty were reviewed at the tertiary referral center. 81 patients who had undergone suturing of the medial crura to the extension graft or to the long septum were selected. In group A, fixation was performed at the same level compared to before surgery. In group B, tip grafting was performed to gain 3 mm or more in projection after fixation as done in group A. In group C, the same tip projection was provided by advancing the medial crura on the caudal septum or extension graft. Patients were evaluated with a visual analog scale, based on the rigidity of the nasal tip (0=very flexible, 10=very rigid). RESULTS: When the preoperative and postoperative VAS scores of all groups were compared, postoperative scores were significantly higher than the preoperative scores (p<0.001). The postoperative scores of group C were higher than those of the other groups. These differences were statistically significant (p<0.001). There was no statistically significant difference between groups A and B with regard to the postoperative scores (p=0.389). However, in group C, the increase between preoperative and postoperative scores was significantly higher than in the other groups (p<0.001). CONCLUSION: Advancing the medial crura on the caudal septum and suturing to gain 3 mm or more of tip projection may result in a more rigid nasal tip. Patients should be informed preoperatively of this potential result. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Importance of laryngologic examination in chronic cough]. / Kronik öksürükte larengolojik muayenenin önemi.

OBJECTIVES: This study aims to investigate the distribution of etiologic factors related to otorhinolaryngology in chronic cough patients with normal lung examination and spirometric findings, and also highlight the importance of videolaryngostroboscopic (VLS) examination with these patients. PATIENTS AND METHODS: Seventy-six patients (31 males, 45 females; mean age 48.0±15.5 years; range 18 to 83 year) who applied to pulmonology outpatient clinic with cough complaint for more than two months were included in the study. After being evaluated by a pulmonologist, patients were referred to otolaryngology outpatient clinic. To detect the underlying cause of cough, patients' detailed histories, and flexible fiberoptic endoscopy and VLS findings were reviewed. Reflux symptom index (RSI) was used for the diagnosis of gastroesophageal reflux. RESULTS: In RSI ≥13 group, posterior commissure edema was detected in 12 patients (42.9%), and posterior commissure hyperemia was detected in four patients (14.3%). These findings were statistically significantly higher than RSI <13 group (p=0.006 and p=0.016, respectively). No significant difference was present between the group of patients with allergic rhinitis and the group of patients without allergic rhinitis in terms of VLS findings. Mucopurulent secretion rate in posterior commissure in patients with acute sinusitis findings was statistically higher than patients without acute sinusitis findings (p<0.001). CONCLUSION: Chronic cough is a common symptom of many different diseases. Therefore, a multidisciplinary approach is important for diagnosis. Videolaryngostroboscopy is a valuable examination tool in the differential diagnosis of gastroesophageal reflux and acute sinusitis.

Cartilage graft or fascia in tympanoplasty in patients with low middle ear risk index (anatomical and audological results).

The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients with low middle ear risk index (MERI). In this retrospective study, 63 patients that underwent type 1 tympanoplasty with chondroperichondrial island graft between July 2009 and November 2010 were compared with 45 patients in whom temporal muscle fascia was used. Patients in both groups had low MERI values varying between 1 and 3. Five and nine patients underwent masteidectomy in cartilage and fascia group, respectively. Mean duration of follow-up was 11.9 ± 3.7 (5-17) months. Mean value was calculated at pre-operative and post-operative hearing threshold 0.5, 1, 2, 4 kHz, and air bone gap (ABG) gain was compared in both cartilage and fascia groups. when pre-operative and post-operative ABG gain were compared, significant decrease was seen in ABG levels (p < 0.001). However, no significant difference was seen in ABG gain values (p = 0.608), which was 10.1 ± 7.00 dB in cartilage group and 10.8 ± 5.38 dB in fascia group. In both groups, age, sex, and the addition of mastoidectomy procedure had no significant effect on ABG gain and success. Cartilage is a graft material that may be preferred without concern about the effects on hearing results, especially, in patients with low MERI values. The addition of mastoidectomy had no impact on the outcome of operation and audiological results. However, further studies with larger case series may be carried out to further clarify the issue.

Zinc Supplementation Improved Neuropeptide Y, Nesfatin-1, Leptin, C-reactive protein, and HOMA-IR of Diet-Induced Obese Rats.

Obesity is a mild chronic inflammation that causes many metabolic diseases. It was aimed to investigate some parameters affective on the energy metabolism by adding zinc (Zn, ZnSO4) to drinking water of diet-induced obese rats. Five-week aged, male Sprague Dawley rats divided into as control group, consuming standard rat diet, and high-fat diet (HFD) group. After obesity induced by feeding HFD for 8 weeks, the obese rats were divided into Zn-supplemented obese group (HFD + obese + Zn; 150 mg Zn/L (for 6 weeks), 235 mg Zn/L (7th week), 250 mg Zn/L (8th week) in drinking water) and obese group (HFD + obese). Mean body weight, serum concentrations of C-reactive protein, neuropeptide-Y, leptin, insulin fasting blood glucose, and HOMA-IR were statistically decreased by given Zn in HFD + obese + Zn group compared to HFD + obese rats. It was observed that the total cholesterol, LDL, and HDL cholesterol levels of HFD + obese + Zn group became closer to the control group level, and Zn supplementation caused a statistically significant decrease in cholesterol profile than HFD + obese rats. Also, increased mean serum nesfatin-1 level, an effective protein for the formation of satiety, was analyzed in HFD + obese + Zn group when compared to HFD + obese ones. Serum triglyceride concentration tended to decrease with the effect of Zn in obese rats. In conclusion, it can be said that oral use of Zn could improve energy balance and prevent the occurrence of metabolic diseases related to obesity depending on the anti-inflammatory effect of Zn.

Pediatric Vocal Fold Nodule Etiology: What Are Its Usual Causes in Children?

OBJECTIVES: In this study, the relation between phonotrauma and presence of siblings and social activities was investigated, and the incidence of voice disorders in the mothers of children with vocal fold nodules was studied with objective (clinical voice analysis) and subjective (laryngostroboscopy, Voice Handicap Index) methods. METHODS: Twenty-nine children with vocal fold nodules (age range 5-14 years), 45 age-matched children without any voice disorders as a control group, and their mothers were included in the study. All patients had laryngostroboscopy and clinical voice analysis, and their mothers filled out the Pediatric Voice Handicap Index. We noted the most common place or situation where children used their voice in excessively high volume according to their mothers, including home, school, sportive activities, and singing or reciting poem activities, to recognize the major cause of phonotrauma. In addition, presence of siblings was recorded. RESULTS: It was found that 15 patients (51.7%) had younger siblings, seven patients (24.1%) had older siblings, five patients (17.2%) had both younger and older siblings, and two patients (6.8%) did not have any siblings. It was seen that excessive usage of high-volume voice at home had a correlation with presence of only younger siblings, and both younger and older siblings tended to cause phonotrauma at home (86.7%). Additionally, eight boys (44.4%) reported presence of sportive activities, whereas none of the girls had such an activity (P = 0.012). CONCLUSION: Presence of siblings seems to be an important factor for vocal nodule formation. Maternal relationship does not seem to be a major factor for vocal misuse.

Patient Characteristics and Frequent Localizations of Rhinoliths.

OBJECTIVE: A rhinolith is a rare entity affecting all people in all age groups. It is defined as a mineralized foreign body. The purpose of the present study was to reveal the distribution in age and gender and the localization, side, and prominent symptoms of rhinoliths to identify the risk groups and characteristics of the rhinoliths in a large case series. METHODS: A retrospective review was performed from the medical charts of 28 patients who were diagnosed with rhinolith and underwent surgery between May 2011 and January 2015 in Ankara Research and Training Hospital. All data, including age, gender, duration of symptoms, localization of the lesion and accompanying pathologies, were documented. RESULTS: In total, 28 patients (18 females and 10 males) with a mean age of 26.2±16.6 (5-62) years who were diagnosed with rhinolithiasis were reviewed. Nasal obstruction (71.4%) and nasal discharge (64.3%) were the most common complaints. The rhinolith was located in the right nasal cavity in 24 patients and in the left in four; this difference was statistically significant (p<0.001). There were 11 accompanying pathologies including nasal septal deviation (n=6), nasal polyposis (n=2), concha bullosa (n=2), and adenoid vegetation (n=1). In 21 (75%) patients, the most common site was the nasal base of the cavity between the inferior turbinate and the nasal septum. CONCLUSION: If unilateral right-sided nasal obstruction with foul-smelling purulent discharge is detected in a young adult and a nasal examination reveals a mass in the floor of the cavity, a rhinolith should be strongly considered in the differential diagnosis.

Improvement of Pulmonary Functions Following Septoplasty: How Are Lower Airways Affected?

OBJECTIVES: Nasal septal deviation is a frequent cause of increased nasal airway resistance. A narrow nasal airway would result in a decreased airflow into the lungs. The aim of the present study was to evaluate the alterations of the pulmonary functions following septoplasty using spirometry and 6 minutes walking test (6mWT). And reveal the correlation of symptom score improvement with nasal obstruction symptom score (NOSE) and sino-nasal outcome test (SNOT22) questionnaires following surgery. METHODS: Thirty patients with obvious nasal septal deviations were enrolled in the study. All patients had a detailed otorhinolaryngologic examination, filled NOSE/SNOT22 questionnaires, performed spirometry and 6mWT preoperatively. One month after surgery, NOSE/SNOT22 questionnaires filled by subjects and spirometry with 6mWT were performed again, and the results were compared. RESULTS: The mean total walking distance was 702.3±68.2 m preoperatively, and it improved to 753.2±72.6 m postoperatively (P<0.001). Total tour count increased from 11 (range, 10.8 to 12.0) to 12 (range, 11 to 13.3), and the difference was found statistically significant (P<0.001). When the preoperative and postoperative mean 6mWT results were compared, diastolic blood pressure increased from 70 to 80 mmHg (P=0.031), heart rate increased from 83.5±13.2 to 90.1±12.5 bpm (P=0.017), dyspnea rate decreased from 1 to 0 (P=0.002), and fatigue scores reduced from 2 to 1 (P=0.003). Evaluation on spirometry findings revealed that FIF50% (maximum inspiratory flow at 50% of forced vital capacity [FVC]) scores and peak expiratory flow (PEF) values improved significantly after surgery. Septoplasty improves the nasal breathing pattern. While reducing FEF50% (maximum expiratory flow at 50% of FVC)/FIF50%, it increases PEF and FIF50% values. In addition, as shown by 6mWT, exercise capacity improves following surgery. Postoperative NOSE and SNOT22 scores reduced markedly compared to preoperative values (P<0.001). CONCLUSION: These findings suggest that nasal septal surgery has a positive effect on pulmonary functions, and this can be an important clue for the relationship of lung disorders and nasal obstruction.

The effect of inlay butterfly cartilage tympanoplasty technique on compliance.

CONCLUSION: IBCT technique should be preferred owing to its high graft survival rate and ABG gain. While no significant difference was found in middle ear pressures between ears that underwent IBCT and normal ears, compliance values were found to be decreased in patients undergoing IBCT. However, the lack of correlation between ABG gain and compliance values indicated that compliance increase had no effect on post-operative ABG results. OBJECTIVE: The aim of the present study was to compare tympanometric and audiological parameters in patients undergoing inlay butterfly cartilage tympanoplasty (IBCT) with their normal ears and to determine their difference with normal ear tympanometric parameters. METHODS: Overall, 25 patients that underwent an operation between August 2010-May 2014 were included in the present study. In 13 of these patients, the ear that did not undergo operation was normal. 0.5, 1, 2, 4 kHz pure sound average values, tympanometric measurements and compliance values of normal and operated ears were compared. RESULTS: The graft survival rate in patients was found to be 92%. Mean pre-operative air-bone gap (ABG) was 16.4 ± 5.4 in patients, while mean post-operative ABG was 10.9 ± 5.8, with a statistically significant difference (p = 0.001) While there was no significant difference between operated and normal ears of patients in terms of middle ear pressure (0.441), compliance values were significantly higher in normal ears than those in operated ears (0.032). When post-operative ABG gain was compared with compliance values, no significant correlation was found between ABG gain and compliance measurements (r = -0.025 and p = 0.936).

The impact of pregnancy on nasal resonance.

OBJECTIVES: This study aims to investigate the possible impact of hormonal changes on nasal resonance during pregnancy. PATIENTS AND METHODS: Between January 2013 and June 2013, a total of 101 pregnant women (mean age 27.1±5.8 years; range 18 to 41 years) visiting obstetric clinics for routine antenatal checkups were included in the study. The control group was consisted of 99 patients (mean age 29.2±6.6 years; range 18 to 42 years) without any nasal complaints. Nasal symptoms were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) Scale. Nasalance scores were calculated by nasometry. The results were compared between study and control groups. RESULTS: The mean nasalance score in pregnant women (40.4±7.8) were statistically significantly lower than the control group (44.7±6.4) (p<0.001). The nasalance score was 43.2±7.0 for the first trimester, 41.1±6.6 for the second trimester, and 39.2±8.8 for the third trimester. There was no statistically significant difference in nasalance scores within three trimesters. The mean nasalance scores of the second and third trimesters were statistically significantly lower than the control group (p<0.001). The NOSE scores were found to be statistically significantly higher in the third trimester (2.9±2.6) than the second trimester (1.1±1.9) (p<0.001). CONCLUSION: These findings indicate that nasalance scores fall in pregnancy, leading to the development of hyponasal voice.

Glass ionomer application for vocal fold augmentation: Histopathological analysis on rabbit vocal fold.

OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate the use of glass ionomer cement (GIC) as an injection material for vocal fold augmentation and to evaluate the biocompatibility of the material. STUDY DESIGN: Ten adult New Zealand rabbits were used. METHODS: Under general anesthesia, 0.1-cc GIC was injected to one vocal fold and the augmentation of vocal fold was observed. No injection was applied to the opposite side, which was accepted as the control group. The animals were sacrificed after 3 months and the laryngeal specimens were histopathologically evaluated. RESULTS: The injected and the noninjected control vocal folds were analyzed. The GIC particles were observed in histological sections on the injected side, and no foreign body giant cells, granulomatous inflammation, necrosis, or marked chronic inflammation were detected around the glass ionomer particles. Mild inflammatory reactions were noticed in only two specimens. The noninjected sides of vocal folds were completely normal. CONCLUSION: The findings of this study suggest that GIC is biocompatible and may be further investigated as an alternative injection material for augmentation of the vocal fold. Further studies are required to examine the viscoelastic properties of GIC and the long-term effects in experimental studies. LEVEL OF EVIDENCE: NA.

Tympanoplasty outcomes in elderly patients.

OBJECTIVE: To investigate the outcomes of tympanoplasty in elderly (≥60 years) compared with young patients (18-59 years). MATERIALS AND METHODS: Patients who had been performed type I tympanoplasty between 2009 and 2012 were retrospectively analyzed. Preoperative and postoperative audiological results and the graft success of 42 older patients were compared with those of 72 younger ones. RESULTS: The mean preoperative air conduction levels were statistically significantly higher in older group (57.4±16.8dB) than younger group (37.3±10.3dB) (p<0.001). Preoperative bone conduction levels were statistically significantly higher in older group (28.5±13.4dB) than in the younger group (12.4±4.8dB) (p<0.001). The mean preoperative and postoperative air-bone gaps were statistically significantly larger in the older group (28.5±11.0dB, 16.4±9.0dB) than in the younger group (24.9±7.7dB, 12.4±8.0dB respectively) (p<0.001). The intragroup comparisons of preoperative and postoperative mean air-bone gaps revealed statistically significant improvements in both groups (p<0.001 for both). Graft success rates and the mean hearing gains were not statistically significantly different between the groups (p=0.225, p=0.786 respectively). CONCLUSION: Although preoperative and postoperative air and bone conduction levels were worse in the older group, graft take rates and postoperative hearing gain did not differ between the groups. If the physical status is stable tympanoplasty procedure can be recommended for elderly patients.