Internal Nasal Valve Expanding Graft for Middle Vault Reconstruction.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre- and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P < 0.05). Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < 0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

Superficial Parotidectomy Versus Partial Superficial Parotidectomy: A Comparison of Complication Rates, Operative Time, and Hospital Stay.

PURPOSE: The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP). MATERIALS AND METHODS: This retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014 and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age and gender), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov-Smirnov test, Mann-Whitney U test, and χ2 test were used to analyze the data. P < .05 was considered statistically significant. RESULTS: The sample was composed of 321 patients (184 men and 137 women) with a mean age of 54.0 ± 14.7 years (range, 18 to 87 years). Of these, 190 underwent SP and 131 underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin tumor (50 patients, 32%). The mean hospital stay was 6.7 ± 2.3 days in the SP group and 4.8 ± 2.4 days in the PSP group (P < .001). The mean operative times in the SP and PSP groups were 134.0 ± 24.6 and 92.1 ± 21.9 minutes, respectively (P < .001). The overall complication rates were 21.6% and 12.2% in the SP and PSP groups, respectively (P = .031). No tumor recurrence was observed in either group. CONCLUSIONS: Compared with the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.

Endoscopic Repair of Persistent Oroantral Communications Using the Caldwell-Luc Approach.

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

Outcomes and Complications of Endoscopic Versus Microscopic Transsphenoidal Surgery in Pituitary Adenoma.

This retrospective study aimed to define outcomes and complications of endoscopic versus microscopic transsphenoidal surgery in pituitary adenoma. Data of 94 patients who underwent transsphenoidal endoscopic (n = 45) or microscopic surgery (n = 49) between June 2000 and June 2014 for pituitary adenoma, performed at Katip Çelebi University Hospital, were retrospectively analyzed. The patients' symptomatology, type of adenoma, radiologic findings, surgical outcomes, and preoperative and postoperative complications were investigated. The total subtotal resection rate was 73.4% (69 patients) and partial resection rate was 26.6% (25 patients). Total subtotal resection rate was 77.6% (38 patients) in the microscopic group and 68.9% (31 patients) in the endoscopic group. Total resection was seen more often in the endoscopic group than in the microscopic group, with no significant difference between the groups. Four patients (8.2%) in the microscopic group had postoperative cerebrospinal fluid leak compared with 3 patients (6.7%) in the endoscopic group. Two patients (2.1%) had hematoma, with 1 patient each in the endoscopic and microscopic group. Panhypopituitarism development rate was higher in the endoscopic group (no significant difference between the 2 groups). One patient (2%) developed blindness in the microscopic group and 1 (2.2%) had meningitis in the endoscopic group. Based on this study, the total resection rate was higher in the microscopic group than in the endoscopic group. However, outcomes and complication rate did not differ significantly between the 2 surgical techniques. Both techniques have advantages and disadvantages. Prospective randomized controlled trials should be conducted to compare the 2 surgical methods.

Prevertebral space invasion in head and neck cancer: negative predictive value of imaging techniques.

OBJECTIVE: This study evaluated the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in prevertebral space invasion in patients with head and neck squamous cell carcinomas (HNSCC). SUBJECTS AND METHODS: This study retrospectively reviewed 197 patients with advanced primary laryngeal or hypopharyngeal carcinoma who underwent laryngectomy and neck dissection at our institution. The MRI and CT findings were compared with the surgical findings and postoperative pathology. RESULTS: In 191 patients, the macro- and microscopic margins of the surgical specimens were tumor-free. In the remaining 6 patients, prevertebral space involvement was observed intraoperatively. MRI predicted the absence of prevertebral fascia invasion in 40 of 42 patients with a negative predictive value of 100% and specificity of 95.2%, while the negative predictive value and specificity of CT were 99.2% and 88.2%, respectively. CONCLUSION: Preservation of the retropharyngeal fat plane on MRI reliably predicts the absence of prevertebral space fixation in patients with advanced HNSCC.

Endoscopic endonasal transsphenoidal surgery for pituitary adenomas.

OBJECTIVE: The objective of this study was to report the efficacy, safety, and outcomes of endoscopic endonasal transsphenoidal techniques for pituitary adenomas. PATIENTS AND METHODS: A retrospective data analysis of 32 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma between February 2011 and December 2013 was performed. The patients' demographic data, clinical presentations, radiologic findings, recurrence rates, and complications were analyzed. RESULTS: There were 14 men and 18 women with age ranging from 23 to 74 years (mean age, 48.6 y). Functioning and nonfunctioning tumors were present in 22 (68.8%) and 10 patients (31.2%), respectively. Among the functioning adenomas, 8 patients (25%) had growth hormone-secreting adenomas, 6 patients (18.8%) had prolactinomas, 5 patients (15.6%) had adrenocorticotropic hormone-secreting adenomas, 2 patients (6.2%) had follicle-stimulating hormone/luteinizing hormone-secreting adenomas, and 1 patient (3.1%) had thyroid-stimulating hormone-secreting adenomas. Of the 32 patients, 20 (62.5%) had pituitary macroadenomas and 12 patients (37.5%) had microadenomas. Total-subtotal tumor resection was achieved in 75% and 45% of the microadenomas and macroadenomas, respectively. Radiologically, 60% of the macroadenomas had suprasellar and carvenous sinus extension. Postoperative cerebrospinal fluid leaks occurred in 3 patients. Two patients developed temporary diabetes insipidus. CONCLUSIONS: Endoscopic transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in these patients.

Osteoplastic flap approach versus orbitotomy in case of orbitofrontal cholesterol granuloma.

A 44-year-old man developed a slow-growing painless left superolateral orbital mass that extended into the frontal sinus with a complaint of ptosis. Magnetic resonance imaging revealed a heterogenous hyperintense lesion confined to the left frontal bone and superior orbit. The osteoplastic frontal sinus approach was performed to drain supraorbital cholesterol granuloma cyst and for curetting the capsule. Orbitofrontal cholesterol granuloma characteristically arises in the diploe of the superolateral frontal bone. The traditional approach for a primarily orbitofrontal cholesterol granuloma is the transorbital approach including anterior orbitotomy or lateral orbitotomy. However, the osteoplastic approach should be kept in mind as an alternative aprroach for the management of supraorbital lesions in patients with well-pneumatized frontal sinus.

Transection of Nasolacrimal Duct in Endoscopic Medial Maxillectomy: Implication on Epiphora.

OBJECTIVE: Management of the nasolacrimal system is usually recommended during medial maxillectomy via external approach because of reported higher rates of postoperative epiphora. Association of the endoscopic medial maxillectomy (EMM) with epiphora, however, is not clearly stated. In this study, we attempted to evaluate whether patients develop epiphora after simple transection of the nasolacrimal duct during EMM. PATIENTS AND METHODS: Medical records of 26 patients who underwent endoscopic tumor resection for inverted papilloma (IP) were retrospectively reviewed. Patients who underwent EMM with nasolacrimal canal transection were included and recalled for lacrimal system evaluation. Twelve patients were eligible for inclusion and fluorescein dye disappearance test (FDDT) was performed for each patient. Patient demographics, tumor data, surgical procedures, and follow-up time were recorded. RESULTS: Of the 12 patients included in the study, 6 underwent canine fossa transantral approach concurrently with EMM. The mean duration of follow-up was 21.1 months (range, 6-84 months). Eight patients were graded as 0, whereas 4 patients were graded as 1 according to FDDT. All test results were interpreted as negative for epiphora. All patients were completely symptom free of epiphora. CONCLUSIONS: Epiphora after EMM with nasolacrimal canal transection among patients with sinonasal tumors appears to be uncommon. Therefore, prophylactic concurrent management of nasolacrimal system including stenting, dacryocystorhinostomy (DCR), or postoperative lacrimal lavage are not mandatory for all patients.

Tracheal Resection With Primary Anastomosis.

The aim of our study was to present our retrospective experience in the single-stage surgical reconstruction of 21 tracheal stenosis (TS) patients during the last 17 years, considering the characteristics of the treated stenosis, surgical procedures performed, and postoperative outcomes and complications. All demographic and clinical data were collected retrospectively. Chest and neck computed tomography (CT) scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Myer and Cotton grading scale. The aetiology of the (TS) was intubation related in 18 patients and idiopathic in three patients. The duration of intubation was 13.00 ±â€Š6.83 days (range, 1 hour to 27 days). According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.33 ±â€Š0.66 (range, 2-4). Mean length of the stenosis was 2.05 ±â€Š0.80 (range, 1-3.5) cm. The mean number of stenotic segment involved was 3.67 ±â€Š1.24 (range, 2-6). Mean follow-up for the study group, excluding two patients who died in the postoperative period, was 57 (range, 12-326) months. Of the 19 patients who survived, postoperative decannulation was achieved in 16 patients (76.19%), and decannulation was not achieved in 3 patients (14.29%) who are still on a T-tube. Of the 16 patients who are decannulated successfully, additional procedures were applied in 9 patients. Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected patients of (TS).

Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients.

OBJECTIVES: This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. PATIENTS AND METHODS: Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. RESULTS: Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. CONCLUSION: Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.

Regulatory-T, T-helper 1, and T-helper 2 cell differentiation in nasal mucosa of allergic rhinitis with olive pollen sensitivity.

BACKGROUND: Allergic rhinitis (AR) is a disease in which T-helper (Th)2 response is predominant and its pathogenic mechanism is still poorly understood. AIM: To evaluate the possible role of Th1, Th2 and regulatory-T (Treg) cells in the pathogenesis of AR. METHODS: This case-control study enrolled 41 patients with seasonal AR (10-62 years old), sensitive to olive pollens, and 15 healthy controls (18-60 years old). Nasal biopsy was performed and specimens of nasal lavage fluid were obtained from all participants. The levels of interleukin (IL)-4, IL-10, interferon (IFN)-γ and transforming growth factor-ß (TGF-ß) were measured in nasal lavage fluid specimens. The expression of FOXP3, GATA-3 and T-bet was measured by immunohistochemical methods in the nasal biopsy specimens. RESULTS: The levels of IFN-γ in the group with AR were significantly lower than those in the control group (p = 0.008). The levels of IL-4, IL-10 and TGF-ß did not differ between the two groups. The expression of FOXP3 and T-bet in patients with AR was significantly lower than that in the control group (both p = 0.001). Expression of GATA-3 in the nasal mucosa was similar between the groups (p = 0.2). The ratios of T-bet/GATA-3 and FOXP3/GATA-3 in the AR group were significantly lower than those in the control group (p = 0.001). CONCLUSION: Insufficient Treg and Th1 cells may be associated with the allergic inflammation that may be attributed to the Th2 immune response in patients suffering from AR who are sensitive to olive pollen.

Endonasal endoscopic approach for recurrent nasolabial cyst.

Nasolabial cysts are rare nonodontogenic cystic lesions in the soft tissue of the midface and usually present with painless asymptomatic swelling in the nasolabial region. Surgical excision via sublabial approach is considered as the standard treatment. However, endonasal endoscopic marsupialization of the cyst is reported as an effective alternative method for nasolabial cysts. Marsupialization of the cyst is believed to integrate the nasolabial cyst into a part of the nasal cavity as an air-containing sinus. In this article, we present an endonasal endoscopic marsupialization technique in case of recurrent nasolabial cyst. To draw attention to this approach, we present our case with current literature.

[Approaches to antrochoanal polyps in adults: long-term comparative results]. / Eriskinlerde antrokoanal poliplere yaklasim: Uzun dönem karsilastirmali sonuçlar.

OBJECTIVES: This study aims to evaluate the long-term results of endoscopic sinus surgery and combined approach with Caldwell Luc procedure for the treatment of antrochoanal polyps. PATIENTS AND METHODS: Between January 2002 and December 2009, 41 patients (24 males, 17 females; mean age 34.7 years; range 14 to 78 years) were retrospectively analyzed. Patients were divided into two groups according to treatment modality: group 1 included 26 patients who underwent endoscopic sinus surgery alone and group 2 included 15 patients who underwent endoscopic sinus surgery in combination with Caldwell Luc procedure. Both groups were compared for recurrence and complication rate. RESULTS: Seventeen of 41 patients were diagnosed with right-sided lesions, while 24 patients had left-sided lesions. Recurrence was seen in three patients, including two were in the group 1 and one was in the group 2. There was no statistically significantly difference between the groups in terms of recurrence and complication rate (p>0.05). Mean follow-up was 50.5 months (range 15 to 94 months). CONCLUSION: Current approach for the treatment of antrochoanal polyps is endoscopic sinus surgery. However, combined approaches should be performed to avoid recurrences, unless removal of antral part of the antrochoanal polyp completely by endoscopic resection is possible. Selection of the combined techniques depends on the surgeon familiarity with the procedure and whether the patient is pediatric case. Combined approach with Caldwell Luc is a safe procedure in adults.

Pharyngocutaneous fistula after total laryngectomy: Less common with mechanical stapler closure.

OBJECTIVES: The aim of the study was to compare the incidences of pharyngocutaneous fistula after total laryngectomy between patients who underwent manual and mechanical suturing for pharyngoesophageal closure. METHODS: In a retrospective and prospective nonrandomized clinical study conducted at a single tertiary medical center between May 2002 and April 2009, we compared the incidence of pharyngocutaneous salivary fistula between two groups of patients after total laryngectomy. Sixty-one consecutive patients who underwent mechanical suturing with a 60-mm linear stapler (group A) were prospectively enrolled, and 121 patients who had undergone manual suturing (group B) were retrospectively reviewed. RESULTS: The groups were similar in terms of age, gender, comorbidities, TNM (tumor, node, metastasis) stage, and laryngeal tumor extension. The incidence of pharyngocutaneous salivary fistula was 4.9% in group A and 19.8% in group B (p = 0.014). CONCLUSIONS: Mechanical stapler closure of the pharynx after total laryngectomy was associated with a significant reduction in the incidence of pharyngocutaneous fistula compared with manual suture in selected cases.

[The evaluation of cordectomy cases without tracheotomy in laryngeal cancer]. / Larenks kanserlerinde trakeotomisiz kordektomi olgularinin degerlendirilmesi.

OBJECTIVES: We evaluated the technique of laryngofissure cordectomy without tracheotomy in patients with T1a laryngeal carcinoma. PATIENTS AND METHODS: Twelve male patients (mean age 55 years; range 47 to 68 years) who were diagnosed with T1a laryngeal carcinoma and treated with cordectomy without tracheotomy between January 2005 and March 2008 in our clinic were evaluated with retrospective review of medical charts. They were all treated with laryngofissure and cordectomy. The cord with carcinoma was excised with the inner perichondrium of thyroid cartilage and surgical margins were examined hystopatologically with frozen section. Postoperative oncologic and functional results were evaluated. RESULTS: None of the patients were treated with preoperative or postoperative tracheotomy. Oral nutrition was initiated on the 3rd postoperative day and the patients were discharged. No tumor recurrences were seen in the postoperative follow-ups. CONCLUSION: Although the surgical area is slightly restricted due to the use of entubation tube, cordectomy without tracheotomy had better functional results and the oncological results were unchanged compared to cordectomy with tracheotomy. Since the procedure is without tracheotomy, psychological adaptation period of the patients was shorter compared to the patients treated cordectomies with tracheotomy.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer.

INTRODUCTION: 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. OBJECTIVE: To investigate the prognostic value of these parameters in patients with head and neck cancers. METHODS: We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. RESULTS: The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm3 (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. CONCLUSION: Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Significant Changes in Trans-Epithelial Barrier Proteins of Adenoid Tissue with Atopic Status in Children.

OBJECTIVES: Adenoid tissue is important in local immune response and epithelial barrier dysfunction of this tissue may contribute to allergies. The aim of this study was to evaluate the relationship between the status of cross-epithelial barrier elements in adenoid tissue lymphoepithelium and inhalant allergen sensitization. MATERIALS AND METHODS: Children aged 5-15 years, who underwent adenotonsillectomy, participated in this study. All subjects underwent skin prick testing with environmental inhalant allergens. Occludin, ZO1, e-cadherin, ß-catenin, desmoglein, desmoplakin, and connexon-43 were stained immunohistochemically in the adenoid tissues obtained and scored by H-score. RESULTS: We enrolled 76 children, 14 among whom were sensitized to environmental allergens. Among the zonula occludens proteins, median H-scores for occludin, claudin, and ZO-1 were significantly lower in the atopic compared to the nonatopic group respectively (p<0.001). Similarly, median H-scores for e-cadherin and ß catenin proteins of the zonula adherens were significantly lower in the atopic group (p<0.001). Both desmoglein and desmoplakin H-scores were significantly lower in the atopic group [60 (50-100) vs 280 (260-300), p<0.001 and 105 (87.5-120) vs 280 (67.25-300), p<0.001 respectively]. Moreover, connexin-43 protein of the gap junction was significantly lower in the atopic group (p<0.001). CONCLUSION: Adenoid tissue, which is the initial point of contact of inhalant allergens demonstrates epithelial barrier junctional protein, changes in children with inhalant allergen sensitization without clinical allergic disease symptoms. Therefore, it may be concluded that epithelial barrier function plays an important role in the development of allergen sensitization versus tolerance.

Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy.

We investigated general and physical predictors of difficult laryngeal exposure in patients undergoing suspension laryngoscopy; 93 patients were included in this prospective study. The patients were classified as difficult laryngeal exposure group or non-difficult laryngeal exposure group based on the laryngeal view in suspension laryngoscopy. Twelve parameters (age, sex, body mass index, neck circumference, full mouth opening, modified mallampati index, hyoid-mental, thyroid-mental, horizontal thyroid-mental, vertical thyroid-mental, sternum-mental distance) that could predict difficult laryngeal exposure were evaluated. Of 93 patients, 22 had difficult laryngeal exposure. Cormack-Lehane score, neck circumference, body mass index, modified mallampati index, hyoid-mental, thyroid-mental, vertical thyroid-mental, and sternum-mental distance showed significant correlation with difficult laryngeal exposure. Based on the multivariate analysis, neck circumference superior to 40 cm, hyoid-mental and sternum-mental distance with respectively a value less than 6.05 and 13.9 cm were independently associated with difficult laryngeal exposure. Muscular neck, hyoid-mental and sterno-mental distance should be considered clinical predictors of difficult laryngeal exposure. Measurements of physical variables at full extension position of the neck are more useful and reliable predictors than neutral position for the risk of difficult laryngeal exposure.

[Evaluation of superior semicircular canal dehiscence in patients with vertigo and tinnitus]. / Vertigo ve tinnituslu hastalarda süperior semisirküler kanal dehissansinin arastirilmasi.

OBJECTIVES: The aim of the study was to investigate the presence of superior semicircular canal dehiscence (SSC) in patients with unknown etilogy of vertigo/tinnitus. PATIENTS AND METHODS: This study was performed prospectively between December 2007 and March 2008. Fifty five patients (23 males, 32 females; mean age 44.5; range 36 to 74 year) with complaints of vertigo and/or tinnitus, of which we couldn,t establish the etiologies, were included in the study. Control group was consisted of 15 patients who didn,t have complaints of vertigo and/or tinnitus. A high resolution temporal bone computed tomograpy (CT) scan (1 mm slice thickness) was performed in all study groups (patients and controls). RESULTS: Thirty nine subjects (72%) had normal odiometric findings. Mild conductive hearing loss was present in 12 (22%) subjects. Two (3%) of the patients had moderate conductive hearing loss and the other two subjects (3%) had mixed type hearing loss. High resolution temporal bone CT scan revealed that 35 (65%) subjects had dehissence around SSC otic capsule whereas 20 (35%) remaining patients yielded no dehissence. Twenty one of 35 patients (60%) with dehissence at SSC had minimum defect and 14 patients (40%) had significant defect. Bilateral defect was present in nine (64%) of 14 patients with significant defect but none of the subjects with minimum defect showed bilateral involvement. None of the control subjects exhibited SSC dehissence with CT imaging. CONCLUSION: Semicircular canal dehissence was found in 65% of the patients with unknown etiology of the vertigo and tinnitus. Physicians should evaluate the SSC dehissence in patients with vertigo and tinnitus as an etiologic factor.

Evaluation of prognostic factors and middle ear risk index in tympanoplasty.

OBJECTIVE: The aim of this study was to examine the role of the prognostic factors and middle ear risk index on the success of tympanoplasty. STUDY DESIGN: Case series. SUBJECTS AND METHODS: The charts of 231 patients who underwent tympanoplasty operations between 2002 and 2007 were reviewed. Prognostic factors such as age, sex, presence of systemic diseases, location and size of perforation, duration of dry period, presence of myringosclerosis, presence of septal and conchal pathology, operation type, and status of the opposite ear and middle ear risk index were investigated. RESULTS: The overall success rate was 74.4%. Multivariate analysis was carried out on significant prognostic factors to obtain independent variables and yielded the following results (95% CI): size of the perforation (<50%) (OR:8.11), healthy opposite ear (OR:5.64), more than 3 months dry period (OR:2.21), absence of myringosclerosis (OR:4.01) and low middle ear risk index (OR:87.1). CONCLUSION: Size of the perforation(<50%), healthy opposite ear, absence of myringosclerosis, more than 3 months dry period, and low middle ear risk index were found to be significant independent prognostic factors.