Endoscopic and Microscopic Tympanoplasty for Adhesive Otitis Media: A Comparative Prospective Analysis.

BACKGROUND This prospective study aimed to compare outcomes and hearing improvement in 51 patients with adhesive otitis media following endoscopic and microscopic tympanoplasty. MATERIAL AND METHODS Between April 2021 and April 2022, 51 patients diagnosed with pars tensa retraction and hearing loss who underwent endoscopic and microscopic cartilage tympanoplasty were included in the study (endoscopic tympanoplasty group: 26 patients, microscopic tympanoplasty group: 25 patients). Pure-tone audiometric data (0.5, 1, 2, and 4 kHz), air-bone gap (ABG), and postoperative graft intake were compared. RESULTS Hearing gain in the ABG was significant in both groups (p<0.05). When the groups were compared for mean hearing gain in the ABG, the difference was significant (p<0.05). The postoperative ABG in the endoscopic group was significantly smaller than that in the microscopic group. When the postoperative air conduction threshold was evaluated, there was no significant difference between the 2 groups at 4 kHz, whereas a significant difference was observed in the endoscopic tympanoplasty group at 0.5, 1, and 2 kHz. Postoperative graft failure and otorrhea were not observed in any of the patients. CONCLUSIONS Pars tensa retractions and adhesive otitis media show comparable outcomes with both endoscopic and microscopic techniques. In endoscopic tympanoplasty, better visualization allows for better hearing outcomes. The endoscopic method, characterized by a wide field of view and a less invasive approach, enhances access to retraction limits.

Effect of ocular fixation on positional nystagmus in BPPV patients.

OBJECTIVE: The quantitative suppression rate of positional nystagmus (PN) by ocular fixation (OF) is unknown. This study aims to analyse the effect of OF on the slow phase velocity (SPV) of PN during diagnostic positional manoeuvres (DPMs) with videonystagmography in patients with benign paroxysmal positional vertigo (BPPV). DESIGN: DPMs were performed on 58 patients with BPPV, 33 (56.9%) of whom were women. OF was initiated when PN was most evident, and recording was continued. The mean SPV of three consecutive nystagmus before (F0) and after (F1) OF initiation was calculated. The rate of suppression of PN by OF was found in percent with the formula (F0 - F1) x 100/F0. STUDY SAMPLE: 58 patients were included in this study. RESULTS: The mean age was 56.1 ± 11.2 (range 27-76). F0 and F1 values were calculated as 5.742 ± 5.589 and 1.948 ± 3.424 degrees/second, respectively (p < 0.001). The rate of suppression of PN by OF was found to be 66.1%. CONCLUSIONS: OF significantly suppresses PN during DPMs in BPPV patients. Elimination of OF during DPMs is important for accurate diagnosis.

Evaluation of effects of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with pure snoring and obstructive sleep apnea syndrome.

AIM: To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea. METHOD: A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student's t test and Chi-square test. RESULTS: Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm3 before treatment to 6.57 ± 2.03 cm3 after treatment (p < 0.005). Change in soft palate thickness did not vary significantly (p < 0.039). The mean soft palate length has changed from 4.13 ± 0.41 to 3.93 ± 0.51 cm (p < 0.001). The preoperative and postoperative measurements of cross-sectional areas and volumes all showed significant difference except velopharynx minimal lateral airway dimension. The operational procedure increased the total upper airway volume much more in men than in women (p < 0.05). CONCLUSION: Results of this study indicate that anterior palatoplasty operation appears to produce significant increase in upper airway volume and cross sectional area. It does not seem to have an effect on lateral airway dimension. Computerized tomography is a quick and noninvasive imaging technique that allows for quantitative assessment of the velopharyngeal patency changes.

Effect of transtympanic betamethasone delivery to the inner ear.

To investigate the effect of transtympanic betamethasone administration on hearing function with histologic correlation, rats were divided into three transtympanic treatment groups: isotonic saline (group I, n = 10), gentamicin (group II, n = 10) and betamethasone (group III, n = 10). Distortion product otoacoustic emission thresholds were compared on day 10. Also histological effects on cellular apoptosis in both the inner and outer hair cells in organ of Corti and spiral ganglion neurons were evaluated. Distortion product otoacoustic emission thresholds were comparable (p > 0.05) between group I and group III in all measurements. Distortion product otoacoustic emission thresholds of group II were significantly elevated in all measurements when compared with group I (p < 0.05) and group III (p < 0.05). In the Terminal deoxynucleotidyl transferase dUTP Nick End Labelling (TUNEL), Caspase-3, Caspase-8 and Caspase-9 staining method the amount of apoptotic cells in group II were significantly elevated in all measurements compared with group I (p < 0.05). In the TUNEL staining method the amount of apoptotic cells in Group III were significantly elevated compared with group I in both the organ of Corti and spiral ganglion neurons (p < 0.05). The overall histological results revealed that the severity of cellular apoptosis caused by betamethasone was somewhere between isotonic saline and gentamicin. Transtympanic betamethasone does not affect inner ear function as measured by distortion product otoacoustic emission responses, but some increase in cellular apoptosis in the organ of Corti and spiral ganglion neurons was observed. These findings suggest that transtympanic betamethasone may have mild ototoxic effects. Further studies are needed to obtain precise results for transtympanic application of betamethasone.

Optimal time for intranasal splint removal after septoplasty: a prospective clinical study.

To investigate the effect of intranasal splint removal time on patient comfort and possible complications after septoplasty. One hundred and nine patients who had septoplasty operations were included in this study. The patients were divided into three groups. In the 1st group (n = 36), splints were removed on the 3rd day after septoplasty; in the 2nd group (n = 36), splints were removed on the 5th day; and in the 3rd group (n = 37), splints were removed on the 7th day. Pain and nasal fullness were evaluated with visual analog scale. Synechia, perforation, hematoma, infection and hemorrhage were recorded after the removal of the splints (postoperative 1, 8 and 24 weeks). For the 1st, 2nd, and 3rd groups, respectively, pain score was 1.96, 2.67, and 2.67; and nasal fullness score was 6.23, 6.04, and 5.48. Nasal synechia was detected in two patients in the 1st group and in one patient in the 2nd group. Early hemorrhage was detected in two patients in the 1st group and one patient in the 3rd group. Infection, septal perforation and hematoma were detected in three patients in the 1st group. There was no difference in hemorrhage, hematoma, synechia and perforation rates between the three groups. There are various opinions in the literature about the ideal removal time of intranasal tampons after septoplasty, but there is no consensus on this topic. Our study shows that removal time of intranasal splints has no effect on patient comfort or possible complications.

An Unexpected Rhinoplasty Complication: Bilateral Nasolabial Cyst.

UNLABELLED: The nasolabial cyst also known as Klestadt's cyst is a rare non-odontogenic soft tissue lesion of the nasal alar region. Aetiopathogenesis of the nasolabial cysts is controversial. Embryonic and developmental theories were considered at pathogenesis of the nasolabial cyst. In addition, surgical or non-surgical trauma is one of the possible theories. This paper reports a case of a 33-year-old male patient that presented with bilateral nasolabial cysts after rhinoplasty and alar base reduction. LEVEL OF EVIDENCE V: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

Partial Treatment During BPPV Diagnostic Maneuvers.

This study examines a case of lateral canal benign paroxysmal positional vertigo (BPPV) where the sequence of diagnostic positional maneuvers may have influenced the release of some canaliths into the utricle. Partial treatment during BPPV diagnostic maneuvers may complicate side identification during supine roll test, especially in canalolithiasis cases.

Effect of drilling on otolithic organ functions in mastoidectomy.

OBJECTIVE: This study aimed to assess the effect of drilling during mastoidectomy on otolithic organ functions and development of benign paroxysmal positional vertigo using objective vestibular tests. MATERIALS AND METHODS: The study included 45 adult patients diagnosed with chronic otitis media who underwent mastoidectomy with drilling. Pre-operative and post-operative assessments included tests for subjective visual vertical deviation and videonystagmography. RESULTS: Subjective visual vertical deviation was significantly higher in post-operative periods. On the third day, the subjective visual vertical deviation was at its maximum (1.4 degrees). Post-operatively, benign paroxysmal positional vertigo was detected in 14 patients (31.1 per cent). The most common type was ipsilateral lateral canal benign paroxysmal positional vertigo (57.1 per cent). CONCLUSION: The effect of drilling on otolithic organ functions in mastoidectomy seems to be temporary and subclinical; however, it potentially could be a risk factor for the development of benign paroxysmal positional vertigo.

[Genetic basis of head and neck cancers and gene therapy]. / Bas ve boyun kanserlerinin genetik temeli ve gen tedavisi.

Surgery and combinations of traditional treatments are not successful enough particularly for advanced stage head and neck cancer. The major disadvantages of chemotherapy and radiation therapy are the lack of specificity for the target tissue and toxicity to the patient. As a result, gene therapy may offer a more specific approach. The aim of gene therapy is to present therapeutic genes into cancer cells which selectively eliminate malignant cells with no systemic toxicity to the patient. This article reviews the genetic basis of head and neck cancers and important concepts in cancer gene therapy: (i) inhibition of oncogenes; (ii) tumor suppressor gene replacement; (iii) regulation of immune response against malignant cells; (iv) genetic prodrug activation; and (v) antiangiogenic gene therapy. Currently, gene therapy is not sufficient to replace the traditional treatments of head and neck cancers, however there is no doubt that it will have an important role in the near future.

Cephalometric analysis in adults with tympanic membrane atelectasis.

OBJECTIVE: This study aims to examine craniofacial morphology (CFM) with cephalometric radiographs in adults with tympanic membrane atelectasis (TMA). METHODS: A total of 50 patients (study group) were included and standardized lateral and anteroposterior cephalograms were performed. The control group consisted of 50 patients. Anteroposterior cephalograms were compared with the normative data. RESULTS: A significant increase in vertical and decrease in horizontal linear measurements were observed in lateral and anteroposterior cephalograms respectively. Except for the facial axis, the angular measurements were not statistically significant. CONCLUSION: Cephalometric data indicate a narrow and elongated but nearly proportional CFM for patients with TMA.

Microtia and congenital aural atresia.

The purpose of this study was to show the clinical characteristics of microtia and congenital aural atresia cases in Turkey and to make the classification. For this purpose, records of 28 patients with microtia who were admitted to the ENT Clinic of Eskisehir Military Hospital, Turkey, between 1995 and 2011 and 3 patients admitted to the ENT outpatient clinic of Kocaeli Derince Education and Research Hospital, Turkey, were analyzed retrospectively. Of the total 31 patients with microtia (35 microtic ears), involvement of the right ear of 20 patients (64.5%), the left ear of 7 patients (22.5%), and bilateral involvement in 4 patients (12.9%) were observed. There was a unilateral involvement in 27 patients (87.1%). According to the Marx grading, 2 patients (5.7%) had grade 1 malformation, 3 (8.6%) had grade 2 malformation, 29 (82.9%) had grade 3 malformation, and 1 (2.9%) had grade 4 malformation (anotia). Although the characteristics of microtia vary in different population, the results in Turkey are consistent with those in the literature.

A case of an apocrine hidrocystoma treated by sublabial approach.

Apocrine hidrocystomas are uncommon cystic proliferations of the apocrine secretory glands. Maxilla is an unexpected involvement site for these tumors. Our study represents the first case of an apocrine hidrocystoma of the maxilla excised by an intraoral (sublabial) approach, being the first to define the radiologic findings of apocrine hidrocystoma on this region. This case is an extremely rare type in terms of the unusual symptomatology, location and size of the tumor. In this article, clinical presentation, surgical findings, histopathological features and treatment of this rare lesion were discussed.

Correlation of Clinical and Pathological Diagnosis and Inflammatory Markers for Patients Undergoing Laryngeal Microsurgery.

BACKGROUND: The purpose of this study was to investigate the rate of concordance between indirect- and direct laryngoscopy and final pathology in patients undergoing laryngeal microsurgery. STUDY DESIGN: Retrospective case study. METHODS: This study was conducted in the Otolaryngology clinic of a tertiary center between January 2017 and June 2020. Archives records of 432 patients, who underwent laryngeal microsurgery because of benign and premalignant lesions or malignancy, were examined. The patients were divided into three subgroups according to pathology results: benign lesions, premalignant lesions, and malignancies. RESULTS: There were 400 laryngeal lesions from 385 patients, that met the inclusion and exclusion criteria, 307 (79.7%) were male and 78 were (20.3%) female. The average age of patients was 52.88 ± 13.21 years. The most common diagnosis was polyp (34.25%) followed by squamous cell carcinoma (27.75%) and Reinke's edema (8.25%) according to final pathology. For the benign laryngeal lesions, a high correlation level was observed regarding the compatibility of the indirect- and direct laryngoscopy diagnosis, and final pathology (P < 0.001). The laryngeal premalignant lesions and malignancies were significantly more common in older age and male gender (P <0.001). Similarly, smoking usage was more frequent in patients with premalignant lesions and malignancy (P <0.001). The neutrophil count, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, neutrophil to platelet ratio as well as CRP value were significantly higher in malignancy group (P <0.05). On the other hand, lymphocyte ratio was smaller in the malignancy group compared with the benign and premalignant lesions, and this difference was significant (P = 0.016). CONCLUSION: Our study demonstrated a high rate of agreement between the clinical diagnosis and pathology results in patients with benign laryngeal lesions, in contrast to premalignant lesions and malignancies. Also, the neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, neutrophil to platelet ratio as well as CRP were shown to be increased in patients with laryngeal malignancies.

Rates of success in hearing and grafting in the perichondrium-preserved palisade island graft technique.

INTRODUCTION: Various graft materials have been used in the tympanoplasty technique. Cartilage grafts are being used increasingly in recent years. OBJECTIVE: The aim of this study was to present the comparative outcomes of the perichondrium-preserved palisade island graft technique previously defined by ourselves. METHODS: We retrospectively compared the hearing and graft success rates in 108 patients with chronic otitis media, who had undergone cartilage tympanoplasty, where both island and perichondrium-preserved palisade graft techniques were used. RESULTS: The success rates among the study and the control groups with regard to graft take were 97% and 93%, respectively. No significant difference was observed between the groups with regard to the postoperative mean pure tone values, improvement in air-bone gaps and reduction in air-bone gaps to under 20dB. However, better results were observed in the study group. CONCLUSION: The perichondrium-preserved palisade island graft technique is an easy method with high graft success rates and hearing outcomes.

[Chronic pain in bone anchored hearing aids]. / Kemige implante isitme cihazlarinda kronik agri.

The complications of bone anchored hearing aids are very rare. The most seen postoperative complication is soft tissue reaction locally occuring around the titanium implant. Chronic headache is a rarely seen complication related to bone anchored hearing aids application. We presented a patient having complaints of chronic headache and burning sensation after bone anchored hearing aids application. Follow up for one year after the operation, despite the local and systemic therapies, there was no improvement of symptoms and the device was compulsorily removed. This rare complication of bone anchored hearing aids application is reviewied in the literature and probable reasons of failure are discussed.

Nasal Septum and External Nasal Deformity Similarities in Monozygotic Twins and Paranasal Computed Tomography Analysis.

Since identical twins occur as a result of the division of one egg, they have the same genetic structure. Therefore, their phenotypes and sex are also always the same. However, due to the effect of environmental factors, some of the characteristics of twins living in different regions appear to develop differently. In our case of 17-year-old maternal twins, we emphasized that nasal pathologies carried a genetic background in terms of their similarity in septum deviation and external nasal deformity, which were determined to have occurred without a history of trauma. The article has also been presented at 10th Turkish Rhinology Congress, 22-25 May, 2014 Antalya, Turkey.

Ginkgo biloba and Lycopene are Effective on Cisplatin Induced Ototoxicity?

OBJECTIVE: The purpose of this study was to examine the anti-ototoxic impact of Ginkgo biloba extract and lycopene on the model of cisplatin-induced ototoxicity in rats. MATERIALS AND METHODS: Thirty-two Wistar albino rats were examined with the distortion product otoacoustic emission (DPOAE) test (MADSEN Capella2 ; GN Otometrics, ICS Medical, Chicago USA), and they were randomly divided into four groups. Group 1 (n=8) was defined as the healthy control group. Cisplatin was given intraperitoneally as single dose of 12 mg/kg to group 2 (n=8), group 3 (n=8), and group 4 (n=8). Group 2 was determined as ototoxic control group. G. biloba extract (100 mg/kg) was given to group 3, and 20 mg/kg lycopene was given to group 4 with orogastric feeding tube daily for 10 days. DPOAE test was repeated on day 10 on all the groups. Finally, histopathological examination was performed. The study has been lead in agreement with the principles by the Institutional Animal Care and Use Committee Review Board at Kocaeli University Medical Center (KOÜ HADYEK- 1/9-14). The animals were treated in accordance with protocols approved by this committee. RESULTS: When DPOAE tests were compared, there was no significant difference in the four groups before the application (p > 0.05). At the end of day 10, in groups 2 to 4, statistically significant changes were observed (p < 0.05). According to the cisplatin group, a significant increase in the DP-grams on G. biloba and lycopene groups was observed (p < 00.5). Corti organ and spiral ganglion neurons of groups 1, 3, and 4 were observed to have weak expression. Strong reactions were determined in organum spirale and some spiral ganglions of the cisplatin group. The striae vascularis damage on group 2 was found to be more significant more compared with groups 3 and 4. CONCLUSION: There is a protective effect of G. biloba and lycopene on cisplatin-dependent ototoxic rat model.

The role of upper airway morphology in apnea versus hypopnea predominant obstructive sleep apnea patients: an exploratory study.

OBJECTIVE: The objective of this study was to investigate the association between upper airway morphology and apnea vs hypopnea predominance in patients with obstructive sleep apnea (OSA) syndrome. METHODS: A retrospective study on consecutively CT scans obtained from 54 OSA patients and 53 non-snoring controls. CT scans were measured to evaluate upper airway and surrounding structures' morphologic characteristics. OSA patients (matched for age, gender and body mass index) compared as two groups; apneic group: apnea ratio >50% and hypopneic group: hypopnea ratio >50%. Morphologic characteristics were analyzed using Kruskal-Wallis test and Pearson's correlation test. RESULTS: Apneic group (17 patients) showed 76.56% apnea rate and hypopneic group (37 patients) showed 78.46% hypopnea rate. Minimal lateral and anteroposterior dimensions of velopharynx in the apneic group (0.86 ± 0.73 and 0.21 ± 0.13 cm, respectively) was statistically lesser from that of the hypopneic group (1.2 ± 0.42 and 0.54 ± 0.22 cm, respectively). Minimum cross-sectional area of the velopharynx was also lesser in apneic group (0.21 ± 0.16 cm2) than that in hypopneic group (0.65 ± 0.38 cm2). Almost all upper airway parameters in both apneic and hypopneic groups were tended to be smaller than in controls. CONCLUSION: Decrease in airway volume does not signify the type of respiratory event, but significant narrowing of velopharynx in both dimensions; thus having the narrowest value below a certain level causes more apnea. Advances in knowledge: We did not find a similar study when we did a literature search, showing the relationship of apnea vs hypopnea predominance and upper airway parameters in CT in patients with OSA.

An often neglected area in crooked nose: middle turbinate pneumatization.

INTRODUCTION: Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. OBJECTIVE: To investigate the association between crooked nose and the presence of a BMT. METHODS: A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. RESULTS: Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p=0.011). CONCLUSION: This study revealed a link between crooked nose and BMT.