Is it useful to use computerized tomography image-based artificial intelligence modelling in the differential diagnosis of chronic otitis media with and without cholesteatoma?

OBJECTIVE: Cholesteatoma is an aggressive form of chronic otitis media (COM). For this reason, it is important to distinguish between COM with and without cholesteatoma. In this study, the role of artificial intelligence modelling in differentiating COM with and without cholesteatoma on computed tomography images was evaluated. METHODS: The files of 200 patients who underwent mastoidectomy and/or tympanoplasty for COM in our clinic between January 2016 and January 2021 were retrospectively reviewed. According to the presence of cholesteatoma, the patients were divided into two groups as chronic otitis with cholesteatoma (n = 100) and chronic otitis without cholesteatoma (n = 100). The control group (n = 100) consisted of patients who did not have any previous ear disease and did not have any active complaints about the ear. Temporal bone computed tomography (CT) images of all patients were analyzed. The distinction between cholesteatoma and COM was evaluated by using 80% of the CT images obtained for the training of artificial intelligence modelling and the remaining 20% for testing purposes. RESULTS: The accuracy rate obtained in the hybrid model we used in our study was 95.4%. The proposed model correctly predicted 2952 out of 3093 CT images, while it predicted 141 incorrectly. It correctly predicted 936 (93.78%) of 998 images in the COM group with cholesteatoma, 835 (92.77%) of 900 images in the COM group without cholesteatoma, and 1181 (98.82%) of 1195 images in the normal group. CONCLUSION: In our study, it has been shown that the differentiation of COM with and without cholesteatoma with artificial intelligence modelling can be made with highly accurate diagnosis rates by using CT images. With the deep learning modelling we proposed, the highest correct diagnosis rate in the literature was obtained. According to the results of our study, we think that with the use of artificial intelligence in practice, the diagnosis of cholesteatoma can be made earlier, it will help in the selection of the most appropriate treatment approach, and the complications can be reduced.

Comparison of Changes in Nasal Skin Sensation After Primary and Revision Rhinoplasty Procedures Using Semmes-Weinstein Monofilament Testing.

BACKGROUND: Numbness of the nasal skin is one of the most common complications following rhinoplasty. OBJECTIVES: The present study investigated postoperative changes in nasal skin sensation among primary and revision rhinoplasty patients and evaluated the recovery outcomes for both groups. METHODS: A prospective, randomized blinded study was undertaken involving 100 primary and 34 revision open rhinoplasty patients and 50 volunteers as control group. Semmes-Weinstein monofilament testing was performed on 7 designated nasal points preoperatively and at postoperative months 1, 3, 6, and 12, and the results were evaluated. RESULTS: Among the primary rhinoplasty patients, the change in reduced sensation on pressure to the tip and infratip over time was significant (P < 0.001), whereas there was no statistically significant difference for the other points. Among the revision rhinoplasty patients, the change in reduced sensation on pressure to the tip, infratip, and base of columella over time was significant (P < 0.001), whereas there was no statistically significant difference at the other points. In a comparison of the revision and primary rhinoplasty patients at all timepoints, a statistically significant reduction in sensation was noted on the application of pressure to all points in the revision patient group (P < 0.001). CONCLUSIONS: This study found that the sense of touch on pressure returned to normal, aside from at the tip and infratip, by the end of month 12 in primary rhinoplasty patients. The revision rhinoplasty patients, in turn, were observed to have reduced sensation on pressure by the end of month 12, with the greatest reduction at the tip, infratip, and columellar base.

The role of insulin-like growth factor I-II receptor on development of pleomorphic adenoma.

Pleomorphic adenoma is a slow-growing salivary gland tumor frequently arising from the parotid gland. In this study, we investigated the role of the insulin-like growth factor I-II receptor (IGFI-IIR) levels on the development of parotid gland pleomorphic adenomas. The study included 20 males and 20 females who had superficial parotidectomy with a histopathological diagnosis of pleomorphic adenoma in Firat University Otorhinolaryngology Clinic between 2000 and 2011. The ages of the patients ranged between 20 and 50 years. The control tissues were obtained unilaterally from the parotid glands of five female and five male cadavers during autopsy, and consisted of 0.5 × 0.5 cm sized normal parotid gland tissues. The expression of IGFI-IIR were measured in both tumor and tumor-free normal parotid tissue in the study group while only the normal parotid tissues were studied in the cadavers. Primary polyclonal antibodies against IGFI-IIR were used with "Streptavidin-Biotin Complex" method for immunohistochemical staining of both the study and the control groups' tissue sections. In this study, the IGFI-IIR levels were found significantly higher in the pleomorphic adenoma tissue (p < 0.05). In addition, IGFI-IIR expression was greater in normal parotid tissues of the study group when compared to the normal parotid tissues of the cadavers. However, the difference was not statistically significant (p > 0.017). Greater expression for IGFI-IIR in pleomorphic adenoma when compared to normal parotid tissues of the patients and the cadavers suggests that IGFI-II may be important factors in the development of pleomorphic adenoma.

Genetic polymorphism of antioxidant enzymes in eosinophilic and non-eosinophilic nasal polyposis.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the paranasal sinuses, and its pathophysiology is not yet precisely known. It is suggested that oxygen free radicals play an important role in the pathogenesis of nasal polyposis. This study aimed to identify genetic polymorphisms of superoxide dismutase (SOD 2), catalase (CAT), and inducible nitric oxide synthase (iNOS) enzymes in eosinophilic CRSwNP and non-eosinophilic CRSwNP patients; the study also aimed to evaluate the effect of genetic polymorphism of antioxidant enzymes on CRSwNP etiopathogenesis. One hundred thirty patients, who received endoscopic sinus surgery due to CRSwNP, and 188 control individuals were included in this study. Nasal polyp tissues were divided into two groups histopathologically as eosinophilic CRSwNP and non-eosinophilic CRSwNP. Venous blood samples were taken from the patient and control groups. Polymorphisms in the Ala16Va1 gene, which is the most common variation of SOD-2 gene, and 21 A/T polymorphisms in catalase gene were evaluated with the restriction fragment length polymorphism method and -277 C/T polymorphism in the iNOS gene was evaluated with the DNA sequencing method. The GG genotype distribution for the (-277) A/G polymorphism in the iNOS gene was a statistically significant difference between eosinophilic CRSwNP and control groups (p < 0.05). The CC genotype distribution for the SOD2 A16V (C/T) polymorphism was not statistically significant in all groups (p > 0.05). The TT genotype distribution for the A/T polymorphism in catalase gene at position -21 was statistically significant differences in eosinophilic CRSwNP and control groups (p < 0.05). Increased free oxygen radical levels, which are considered effective factors in the pathogenesis of CRSwNP, can occur due to genetic polymorphism of enzymes in the antioxidant system and genetic polymorphism of antioxidant enzymes in eosinophilic CRSwNP patients might contribute to the pathophysiology.

Carotid Body Tumor: Clinical Features.

Although carotid body tumor (CBT) is a rare neoplasm, it should always be considered in differential diagnosis of lateral neck masses. We shared the 10 years of CBT experience in our clinic and started a discussion on CBT with literature support. A total of 21 patients with CBT diagnosis in Firat University Hospital, Otorhinolaryngology Clinic, participated in the study. Patients were evaluated based on demographical data and particularities of the tumor. Participant patients were 19 women and 2 men, and their ages were between 21 and 79 (mean age 54.06 ± 12.48). The most frequent reason for the patients to apply to the hospital was painless swelling in the neck (76.2%). Tumor was located in the right side of the neck in 10 patients (47.6%), and in the left side of the neck in 11 (52.4%). Twenty patients (95.2%) had undergone computerized tomography angiography. Surgical treatment was applied to 19 patients (90.5%) and the tumor was totally excised. According to Shamblin classification, 15 of the tumors of these patients were class II (78.9%) and 4 were class III (21.1%). In 1 patient (5.3%), postoperative contusion infection that recovered after medical treatment was observed; in 2 patients (10.5%), n. vagus injury was observed because of tumor's pervasion of n. vagus; and in 1 of these patients vocal cord paralysis was developed and this patient was later taken into thyroplasty surgery. Two patients (10.5%) suffered n. hypoglossus injury, 1 of these recovered within 3 months postoperative and the other developed n. hypoglossus palsy. The size and extension of the tumor should be determined by preoperative imaging for the correct planning of surgical procedure. It should be taken into consideration that despite advanced surgical techniques, the rate of postoperative cranial nerve damage is still high.

The effect of methylprednisolone on facial nerve paralysis with different etiologies.

OBJECTIVES: The objective of this study was to evaluate the effectiveness of methylprednisolone (MP) in models of facial nerve paralysis obtained by nerve section, compression, or inoculation with herpes simplex virus (HSV). STUDY DESIGN: Experimental controlled animal study. SETTING: Tertiary referral center. METHODS: A total of 30 female New Zealand rabbits weighing 1200-3000 g were used for the study. They were randomly assigned to one of 6 groups of 5 animals each. A nerve section injury was realized in Groups 1a (section and MP) and 1b (section, control) rabbits. A compression-type injury was inflicted to rabbits in Groups 2a (compression and MP) and 2b (compression, control). As for animals in Groups 3a (Type 1 HSV and MP) and 3b (Type 1 HSV, controls), facial nerve paralysis resulting from viral infection was obtained. Animals in the 3 treatment groups, designated with the letter "a", were administered MP, 1 mg/kg/d, whereas those in control groups "b" received 1 mL normal saline, both during 3 weeks. All subjects were followed up for 2 months. At the end of this period, all animals had the buccal branch of the facial nerve excised on the operated side. Semi-thin sections of these specimens were evaluated under light microscopy for the following: perineural fibrosis, increase in collagen fibers, myelin degeneration, axonal degeneration, Schwann cell proliferation, and edema. RESULTS: No significant difference was observed (P > 0.05) between the MP treatment group and the control group with regard to perineural fibrosis, increase in collagen fibers, myelin degeneration, axonal degeneration, edema, or Schwann cell proliferation. In the group with a compressive lesion (Group 2), controls were no different from MP-treated animals as to perineural fibrosis, increase in collagen fibers, or Schwann cell proliferation, whereas axonal degeneration, myelin degeneration, and edema were significantly higher (P < 0.05) in the control group. When comparing the treatment and control groups among the animals inoculated with Type 1 HSV, no significant difference was found with regard to perineural fibrosis, axonal degeneration, myelin degeneration, or Schwann cell proliferation. The only statistically significant advantage of the treatment group was in edema formation (P < 0.05). CONCLUSIONS: As a result of the evaluation of MP efficacy in different models of facial nerve palsy, we may say that this drug was without effect on nerve healing in paralysis due to nerve section and that it only reduced nervous edema in paralysis induced by Type 1 HSV, whereas it had positive effects on healing in the type of paralysis caused by nerve compression.

Prognostic value of serum anti-heat-shock protein 70 and paraoxonase levels in idiopathic sudden sensorineural hearing loss.

OBJECTIVES: This study aims to investigate the correlation between serum anti-heat-shock protein 70 (anti-HSP 70) levels, serum paraoxonase (PON) levels and prognosis of idiopathic sudden sensorineural hearing loss (ISSHL). PATIENTS AND METHODS: Twenty-five patients with ISSHL as the study group and 25 healthy volunteers as the control group were enrolled in this study. Blood samples were obtained from all patients before the treatment initiation and on the 10th day of the treatment from only patients of the study group. Idiopathic sudden sensorineural hearing loss was defined as the hearing loss between 250-6.000 Hz frequencies. The recoveries in the hearing thresholds were evaluated at 10 days of the treatment. RESULTS: When the pre-treatment serum PON, anti-HSP 70 levels and the post-treatment serum PON, anti-HSP 70 levels of the patients with ISSHL were compared, we observed that the post-treatment serum PON levels of the recovered patients increased, while the post-treatment serum anti-HSP 70 levels of recovered patients decreased. CONCLUSION: We believe that serum levels of anti-HSP 70 and PON can be used as markers for estimating and evaluating the prognosis of ISSHL patients.

Comparison of the histologic changes in conchae induced by radiofrequency thermal ablation and submucosal diathermy.

Objective of study was to determine the histological change induced in the conchae by submucosal diathermy and radiofrequency thermal ablation, two techniques used in the treatment of lower conchal hypertrophy, and to compare the two methods to each other. The study was performed on 15 rabbits. Radiofrequency was applied to the study animals in Group I (n = 5) and submucosal diathermy to Group II (n = 5), while Group III (n = 5) was the untreated control. The animals were decapitated 21 days after treatment and their conchae nasales ventrales excised on both sides. Histology slides were prepared and evaluated by light microscopy for ciliary loss, increase in submucosal vascularity, loss of goblet cells, inflammatory cellular infiltration, fibrosis and epithelial damage. The differences between Groups I and III were not significant regarding ciliary loss, increase in submucosal vascularity, loss of goblet cells and epithelial damage (p > 0.05), while the inflammatory cellular infiltration and fibrosis were significantly different between these groups (p < 0.05). As for the differences between Groups II and III, they were significant for each of the compared parameters (p < 0.05), while among Groups I and II they were significant for ciliary loss (p < 0.05), increase in submucosal vascularity, loss of goblet cells, inflammatory cellular infiltration and epithelial damage but not fibrosis (p > 0.05). Based on these findings, we can state that the use of radiofrequency thermal ablation causes less change in the normal conchal histology than submucosal diathermy application.

Prenatally exposure to exogenous glucocorticoids and stress may affect the inner ear.

OBJECTIVES: This study aims to investigate the effect of exogenous glucocorticoid exposure in the prenatal period on hearing and to evaluate the effectiveness of caffeic acid phenethyl ester (CAPE), an antioxidant, on the prevention of the inner ear injury. MATERIALS AND METHODS: Dexamethasone was given to half of twelve Sprague-Dawley pregnant rats and the distilled water was given to the remaining half. The real subjects were obtained by born of the offsprings. When the all subjects were two months of age, they were exposed to 110 dB noise during four hours as a stressor effect. These subjects were divided into three groups. Group 1: subjects to whose mothers were given distilled water; Group 2: subjects to whose mothers were given dexamethasone; Group 3: subjects to whose mothers were given dexamethasone and CAPE. RESULTS: While there was no statistical significance in hearing thresholds which exposed and not exposed to exogenous dexamethasone before noise exposure (p>0.05) between the groups, the elevation of hearing thresholds of subjects which exposed to exogenous dexamethasone was statistically significant after noise exposure (p<0.05). CONCLUSION: Prenatally exposure to exogenous glucocorticoids may cause the inner ear susceptible to the effect of noise, and CAPE is effective to prevent the possible damage.

Comparison of Computed Tomography-Based Artificial Intelligence Modeling and Magnetic Resonance Imaging in Diagnosis of Cholesteatoma.

BACKGROUND: In this study, we aimed to compare the success rates of computed tomography image-based artificial intelligence models and magnetic resonance imaging in the diagnosis of preoperative cholesteatoma. METHODS: The files of 75 patients who underwent tympanomastoid surgery with the diagnosis of chronic otitis media between January 2010 and January 2021 in our clinic were reviewed retrospectively. The patients were classified into the chronic otitis group without cholesteatoma (n=34) and the chronic otitis group with cholesteatoma (n=41) according to the presence of cholesteatoma at surgery. A dataset was created from the preoperative computed tomography images of the patients. In this dataset, the success rates of artificial intelligence in the diagnosis of cholesteatoma were determined by using the most frequently used artificial intelligence models in the literature. In addition, preoperative MRI were evaluated and the success rates were compared. RESULTS: Among the artificial intelligence architectures used in the paper, the lowest result was obtained in MobileNetV2 with an accuracy of 83.30%, while the highest result was obtained in DenseNet201 with an accuracy of 90.99%. In our paper, the specificity of preoperative magnetic resonance imaging in the diagnosis of cholesteatoma was 88.23% and the sensitivity was 87.80%. CONCLUSION: In this study, we showed that artificial intelligence can be used with similar reliability to magnetic resonance imaging in the diagnosis of cholesteatoma. This is the first study that, to our knowledge, compares magnetic resonance imaging with artificial intelligence models for the purpose of identifying preoperative cholesteatomas.

Can prestin level be a biomarker for determining sensorineural hearing loss?

OBJECTIVE: To determine prestin levels in patients with sensorineural hearing loss and to assess whether the prestin level could be a determining factor in predicting sensorineural hearing loss. MATERIAL AND METHODS: The study was carried out with patients that presented to the Department of Otorhinolaryngology of Firat University. Patients were divided into four groups of 30 subjects. Group 1: individuals aged ≥55 years with no hearing loss (control group); Group 2: individuals aged 20 to 55 years with no hearing loss (control group); Group 3: individuals aged 20 to 55 years with sensorineural hearing loss; Group 4: individuals aged ≥55 years with presbycusis. Following an audiometry examination, 5 cc blood was taken from all patients to assess serum prestin levels. RESULTS: Prestin levels were 445.32 pg/mL in Group 1; 452.79 pg/mL in Group 2; 123.64 pg/mL in Group 3; and 79.54 pg/mL in Group 4. No difference was found between the serum prestin levels of the younger patients with hearing loss (Group 3)] and of the patients with presbycusis (Group 4) (p=0.084). No difference was found between the serum prestin levels of the younger (Group 1) and the older (Group 2) patients with presbycusis (p=0.399). Significant differences (with higher levels in the control groups) were found in between the prestin levels of between Group 3 (the younger patients with sensorineural hearing loss) and Group 2 (younger controls), and between Group 4 (older patients with presbycusis) and Group 1 (older controls) (p<0.001 and p <0.001, respectively). CONCLUSION: Serum prestin levels can be used as biomarkers for assessing patients with presbycusis and sensorineural hearing loss. They can also be used together with audiometry tests to predict the patient's potential level of hearing loss.

Vestibular functions in patients with idiopathic sudden sensorineural hearing loss and its relation to prognosis.

OBJECTIVE: Because of the anatomically close relationship between the cochlea and the vestibular organs, cochlear function disorders may be accompanied by vestibular disorders. This study aimed to evaluate vestibular functions in patients with idiopathic sudden sensorineural hearing loss using VEMP, caloric test, and VNG test battery and its relation to prognosis. MATERIALS AND METHODS: For this study, 42 patients aged 18-55 years with idiopathic sudden sensorineural hearing loss and 30 volunteers who had no hearing and balance problems were included. Audiometry, cVEMP, oVEMP, caloric tests, and VNG tests were performed. Moreover, the effects of age, sex, time of admission, degree and configuration of hearing loss, accompanying vertigo, tinnitus, and ear fullness on improvement in hearing were evaluated. RESULTS: Of the 42 patients in the study group, 26 (56.52%) were male, 20 (43.48%) were female, and the mean age was 41.54 ± 12.23 years. Of the 30 individuals in the control group, 19 (63.3%) were male, 11 (36.7%) were female, and the mean age was 39.53 ± 13.03 years. There was no significant difference in the incidence of sudden sensorineural hearing loss in terms of sex and age, and the prognosis was better for female patients. Early admission to treatment was a factor of good prognosis; profound hearing loss, bilateral hearing loss and vertigo were factors of poor prognosis. Prognosis was better in patients with rising type audiogram configuration, while the prognosis was worse in patients with flat, descending and total hearing loss. Tinnitus and ear fullness had no effect on the prognosis. No anomalies were observed in VNG findings. Moreover, abnormal caloric response was higher in patients with profound hearing loss and total hearing configuration. Shortening was observed in cVEMP / oVEMP P1 and N1 latency after treatment. Furthermore, there was an improvement in abnormal responses after treatment. CONCLUSION: In this study, vestibular function was affected in patients with idiopathic sudden sensorineural hearing loss. The present study can help the development of a clinical strategy in the evaluation of the vestibular system in idiopathic SSNHL, patient follow-up, patient information, and the implementation of vestibular rehabilitation. Note that additional studies involving larger patients series are required.

Efficacy of glial growth factor and nerve growth factor on the recovery of traumatic facial paralysis.

The aim of this study was to assess the effects of Glial growth factor (GGF) and nerve growth factor (NGF) on nerve regeneration in facial nerve anastomosis. In this study, approximately a 1-mm segment was resected from the facial nerve and the free ends were anastomosed. All animals underwent the same surgical procedure and 30 rabbits were grouped randomly in three groups. Control group, the group without any medications; NGF group, the group receiving 250 ng/0.1 ml NGF in the epineurium at the site of anastomosis; GBF group, the group receiving 500 ng/0.1 ml GGF in the epineurium at the site of anastomosis. Medications were given at the time of surgery, and at 24 and 48 h postoperatively. After 2 months, the sites of anastomosis were excised and examined using the electron microscope. It was found that the best regeneration was in the group receiving GGF as compared to the control group in terms of nerve regeneration. Schwann cell and glial cell proliferation were found to be significantly higher in the group receiving GGF as compared to the group receiving NGF. Besides, the number of myelin debris, an indicator of degeneration, was significantly lower in the group with GGF as compared to NGF and control groups (p < 0.005). Using GGF and NGF in order to increase regeneration after nerve anastomosis in experimental traumatic facial nerve paralysis may be a hopeful alternative treatment option in the future. However, further studies on human studies are required to support these results.

The evaluation of vestibular functions in patients with pseudoexfoliation syndrome.

The main objective of the study is to evaluate vestibular system of the inner ear with postural tests in the patients with pseudoexfoliation syndrome (PEX). It is clinical case-control study. The study group included 34 patients with PEX and 40 controls without PEX. The patients and controls underwent complete ophthalmic and otorhinolaryngologic examinations. Vestibular functions were done by Fitzgerald and Dix-Hallpike, caloric tests, Romberg test, tandem Gait test, Quiks test in both control and study groups. Pur-tone and high-frequency audiography were also performed in all cases. The mean patient age was 63 years (+/-11.80) (range 47-74 years) in the PEX group and 65 years (+/-8.70) (range 61-68 years) in the control group with no differences among the two groups (P > 0.05). Although none of the 34 patients with PEX had clinical history of balance disturbance, 21 (61.76%) had significant pathologic sign in vestibular function tests (P < or = 0.05), while only 3 (7.5%) of 40 cases in the control group had pathologic sign in vestibular function tests. The scales from pure tone and high-frequency audiogram in the PEX group were similar to those of the control group. In conclusion, the patients with PEX, there may be a vestibular involvement in the pathological level in the inner ear. Larger clinical studies, experimental animal studies, and post mortem studies in humans are needed to disclose the pathology in the vestibulocochlear system in the patients with PEX.

Histopathologic and functional effects of facial nerve following electrical stimulation.

The aim of the study is to investigate the functional and histopathologic changes in facial nerve due to the application of various violent and numerous electrical stimuli to the facial nerve. The study was carried out with Wistar rats weighing between 200 and 300 g. The facial nerves of the subjects were located and stimulated with electrical stimulator. Then five groups were created with 18 subjects in each group: Group 1, 1 milliampere (mA) electrical stimulus applied; Group 2, 2 mA electrical stimulus applied; Group 3, 3 mA electrical stimulus applied; Group 4, 4 mA electrical stimulus applied; Group 5, 5 mA electrical stimulus applied. All groups were divided into three sub-groups, each consisting of six subjects. The facial nerves of the subjects in first sub-group were stimulated 10 times, in second sub-group were stimulated 20 times and those in third sub-group were stimulated 30 times. The functions of the facial nerves were evaluated on first day, first week and first month, respectively. The facial nerves with branches were dissected from the surrounding tissues carefully. These specimens were investigated by light microscope about axonal degeneration, macrovacuolization and vascular congestion. Loss of facial functions was not observed in the subjects during follow-up process. There was no significant difference between groups regarding axonal degeneration, macrovacuolization and vascular congestion (P > 0.05). While less axonal degeneration was observed in group which was stimulated 10 times, more axonal degeneration was observed in groups which were stimulated 20 and 30 times (P < 0.05). The axonal degeneration, macrovacuolization and vascular congestion were observed more in 1-day groups (P < 0.05). Consequently, lesser violence and lesser number of electrical stimulus application to the facial nerve appears to be an important criterion for not damaging the facial nerve in patients in whom stimulators have been used.

The effect of topical ciprofloxacin and steroid-containing ear drops for chronic suppurative otitis media on the internal ear.

Aim of the study is to evaluate the effects of topical ciprofloxacin and prednisolone-containing ear drops for chronic suppurative otitis media on hearing threshold, cochlear reserve and cochlea morphology in healthy subjects and to determine the proper drug dose. Sixty-eight guinea pigs, all of which had healthy hearing, were used for the study. The first group (n = 30) was administered ciprofloxacin three times a day, the second group (n = 30) was administered prednisolone three times a day and the third group (n = 8) was administered sterile distilled water three times a day. The therapies lasted for 7 days and were administered intratympanically. The first group and second group were divided into three sub-groups of ten subjects. The first sub-group (n = 10) was administered an equivalent dose per kilogram as in humans, the second sub-group (n = 10) was administered one-third of the human-equivalent dose and the third sub-group (n = 10) was administered tenfold the human-equivalent dose. All subjects underwent brainstem evoked response audiometry (BERA) and distortion product otoacoustic emission (DPOAE) testing on the seventh and twenty-first days following the therapy. Following the tests, two subjects from each group were decapitated and examined under electron microscope. BERA and DPOAE testing results of the sub-group (n = 10) which was administered tenfold the human-equivalent dose were significantly different from the control group and other groups (P < 0.05). According to electron microscopic examination of the cochlea, the group which was administered a tenfold human-equivalent dose of intratympanic ciprofloxacin and prednisolone showed atrophy in cells and degenerations in cilia. This case was statistically significant when compared with the control group and other groups (P < 0.05). Ciprofloxacin and prednisolone applied at a human-equivalent dose per kilogram did not affect the hearing and cochlear histology of subjects.

The effects of methylprednisolone and halofuginone on preventing esophageal and hypopharyngeal fibrosis in delivered radiotherapy.

In this study, we assessed the effects of halofuginone and methylprednisolone on hypopharyngeal and esophageal stricture that can develop following radiation to the head and neck of rats. Rats were divided into four groups randomly and 18 Gy radiation was given to the head and neck regions of all rats except the control group. Group 1 (Control Group): No radiation or drugs were administered. Group 2 (Radiation Group): only radiation was applied without any drugs. Group 3 (Halofuginone Group): halofuginone 100 microg/kg per day was given intraperitoneally. Group 4 (Methylprednisolone Group): methylprednisolone 1 mg/kg per day was administered intramuscularly. In all groups, 90 days after application of radiation, sections of the proximal esophagus and hypopharynx were examined for fibrosis, fibroblast proliferation, vascularization, epithelial atypia, necrosis, polymorphonuclear leukocytes, mononuclear cells, and stenosis index by light microscope and the hydroxyproline levels were assessed biochemically. Fibrosis, epithelial atypia and hydroxyproline levels were found to be significantly higher in the radiation group compared to the control group (P < 0.05). We did not observe fibrosis in either the halofuginone or the control groups. Fibrosis was also significantly lower in the methylprednisolone group than the radiation group (P < 0.05). The differences of the stenosis index scores between the groups were not statistically significant (P < 0.05). Vascularization was similar in all groups. We think that especially halofuginone is a drug that can be used safely to prevent fibrosis due to radiotherapy, but further studies are needed.

Histopathologic changes in guinea pig mastoid mucosa after topical mitomycin C application followed by mastoidectomy.

PURPOSE: This study was performed to investigate the histopathologic changes observed in mastoid cavity of guinea pigs after the application of mitomycin C after mastoidectomy. MATERIALS AND METHODS: The study was performed on 50 guinea pigs. Unilateral (right ear) mastoidectomy was performed on all guinea pigs. Twenty-five guinea pigs were separated as study group and the remaining were separated as control group. A mitomycin C-soaked sponge was placed in the mastoid cavities of the study group and a dry sponge was placed in those of the control group. Their mastoid cavities were examined histopathologically for absorbable sponge waste, abscess formation, fibrosis, vascularization, polymorphonuclear leukocyte infiltration, edema, lymphoplasmacytic inflammatory infiltration, and granulation tissue. RESULTS: Absorbable sponge waste, abscess formation, fibrosis, vascularization, edema, and lymphoplasmacytic inflammatory infiltration were not significantly different between the groups. However, polymorphonuclear leukocyte infiltration and granulation tissue were statistically different between the groups. CONCLUSION: Mitomycin C can be used after mastoidectomy to decrease the granulation tissue formation in ear discharges and to prevent the discharge.

[Retropharyngeal abscesses: a retrospective analysis of 10 patients]. / Retrofarengeal apse: 10 olgunun geriye dönük degerlendirilmesi.

OBJECTIVES: Retropharyngeal abscess is a serious and life-threatening disease due to its anatomic location and potential to obstruct the upper airway. We evaluated the clinical characteristics, diagnosis, and treatment of patients with retropharyngeal abscesses. PATIENTS AND METHODS: The study included 10 patients (6 males, 4 females; mean age 9+/-11 years; range 4 months to 32 years) who received medical and surgical treatment with the diagnosis of retropharyngeal abscess. The patients were evaluated with respect to etiology, clinical symptoms and signs, treatment, complications, and hospital stay. RESULTS: The most frequent etiological factor was upper airway infection (70%), followed by dental abscess in two patients (20%), and soft tissue injury due to foreign body ingestion in one patient (10%). The presenting symptoms and signs included dysphagia (100%), respiratory distress (80%), limited neck motion (80%), fever (60%), and neck pain (50%). Treatment consisted of surgical drainage and parenteral antibiotic combination of cefazolin sodium and metronidazole. The mean hospital stay was 7.1+/-5.3 days. Complications were seen in two patients, being empyema and upper airway obstruction, respectively. CONCLUSION: Surgical drainage combined with early antibiotic treatment is an effective method in the management of retropharyngeal abscesses and in preventing complications.

The Protective Effect of Cortexin on Cisplatin-Induced Ototoxicity.

OBJECTIVE: The aim of this report is to evaluate whether cortexin provides any protective activity against ototoxicity of cisplatin. MATERIALS AND METHODS: The study was performed on 30 healthy adult Wistar Albino rats, and rats were randomly divided into three groups of ten. Group I (Control group) was given intraperitoneal (ip) saline solution 1 mL/day. Group II (Cisplatin group) was given ip cisplatin for 2 days at doses of 10 mg/kg. Group III (Cisplatin + Cortexin group) was given ip cisplatin for 2 days at same doses with ip cortexin 2 mg/day for 7 days. Before and on the fourth day of the study, all subjects underwent auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE) tests. At the end of fourth day, half of the subjects in all three groups were decapitated, and their cochlea were removed for histopathologic examination. On the eighth day, tests of the remaining subjects and histopathological examinations were repeated. RESULTS: ABR tests on the fourth and eighth days showed elevations in the mean hearing thresholds of Groups II and III compared to Group I (p < 0.05). DPOAE tests revealed a loss in emission values on the fourth and eighth days of the study compared to the baseline in Groups II and III. Comparison of Groups II with III showed that emission loss was higher in Group II at both time points, and the difference was more pronounced on the eighth day. Histopathological findings supported these tests. CONCLUSION: Cortexin provide protective activity against cisplatin-induced ototoxicity.