A case of sudden hearing loss associated with ANCA.

A 46-year-old female patient presented to our clinic with complaints of aural fullness and hearing loss for two days. On audiometric examination, she had sensorineural hearing loss in the left ear. Mean pure tone audiometry (PTA) was 53dB. Her medical history was significant for oral medication-controlled diabetes mellitus and chronic thyroiditis. Laboratory studies showed an erythrocyte sedimentation rate (ESR) of 40 mm/h and an anti-neutrophil cytoplasmic antibody directed against myeloperoxidase (MPO-ANCA) level of 33.1 EU/ml. ANCA-associated vasculitis was considered. The patient was started on immunosuppressive treatment. Seven months after the initial episode, the patient suffered a relapse. At 17 month follow-up after the initial event, the patient is healthy with normal hearing. Serum MPO-ANCA is within normal limits.

Effect of septoplasty and per-operative antibiotic prophylaxis on nasal flora.

OBJECTIVES: Septoplasty is one of the most commonly performed procedures in otolaryngology practice. Prophylactic use of antibiotics is controversial. Disruption of nasal flora may predispose individuals to infection. We investigated the effect of antibiotic prophylaxis and septoplasty on nasal flora. METHODOLOGY: We included 115 consecutive patients who underwent septoplasty because of symptomatic nasal septal deviation. Patients were divided into study and control groups. Study patients received prophylactic parenteral sodium cefazoline twice a day beginning intra-operatively and while the nasal packing remained in the nose for 48 h, and expandable polyvinyl acetate (Merocel) packing covered with antibiotic ointment containing 0.2% nitrofurazone was inserted into each nostril at the end of the operation. Control patients received neither parenteral antibiotic prophylaxis nor antibiotic ointment around the Merocel packs. Both groups received oral prophylactic cefuroxime axetil for 5 d after nasal packing was removed. Nasal flora was determined pre-operatively, post-operatively when nasal packing was removed, and 3 mo after surgery. RESULTS: Study patients were compared to control patients at pack removal and 1 mo after surgery The effect of antibiotic use in septoplasty on nasal flora was as follows: Increased isolation rate of gram-positive rods (p = 0.007), decreased methicillin-sensitive coagulase-negative staphylococci (p = 0.002). Pre-operative and post-operative culture results at 3 mo were compared. The effect of septoplasty on nasal flora was as follows: Decreased coagulase-negative staphylococci (p = 0.05), decreased Klebsiella (p < 0.001), decreased gram-positive rods (p < 0.001), increased methicillin-sensitive Staphylococcus aureus (p < 0.001). CONCLUSIONS: Septoplasty increases S. aureus colonization and decreases normal flora. Antibiotics do not protect against S. aureus colonization and contribute to a decrease in normal flora. Antibiotics do not seem to confer benefit in terms of flora changes. Studies investigating flora changes with a longer follow-up should be conducted.

The effect of local application of insulin-like growth factor for prevention of inner-ear damage caused by electrode trauma.

BACKGROUND: Electrode insertion during cochlear implantation causes cochlear damage and apoptosis. Insulin-like growth factor applied locally was investigated in 21 rats. METHODS: In the sham group, an intracochlear dummy electrode was inserted through the round window. In the control group, after the same insertion procedure, saline-soaked porcine skin gelatine was placed on the round window. In the study group, insulin-like growth factor 1 soaked gelatine was placed on the round window. Auditory brainstem response thresholds were measured and histopathological examination was performed. RESULTS: In the study group, at 2-4 kHz, one rat had deterioration, one showed improvement and the rest had stable thresholds 14 days after intervention. At 6 kHz, four rats showed improvement and the rest remained stable. At 8 kHz, four showed improvement, one had deterioration and two remained stable. In the other groups, hearing loss deteriorated in about half of the rats and remained stable in the rest. The mean post-operative 6 kHz threshold was significantly lower than that immediately after the intervention in the study group, contrary to the other groups. The study group had significantly better mean histopathological grading than the other groups. CONCLUSION: Local insulin-like growth factor 1 application may protect hearing after cochlear implantation.

Is hyperbaric oxygen therapy a salvage treatment option for sudden sensorineural hearing loss?

OBJECTIVE: To investigate of the efficacy of hyperbaric oxygen therapy as a salvage treatment after unsuccessful oral corticosteroid therapy. METHODS: Case notes of patients who were followed up because of idiopathic sudden sensorineural hearing loss between 2005 and 2011 in a tertiary care centre were examined retrospectively. Audiograms from before and after hyperbaric oxygen therapy were examined in terms of mean gains in pure tone average and at 0.25, 0.5, 1, 2, 4 and 8 kHz. In addition, recovery according to Siegel's criteria was noted. RESULTS: Mean gain in pure tone average was 10.55 ± 13.56 dB. Mean gains at 0.25, 0.5, 1, 2, 4 and 8 kHz were 16.66 ± 18.43 dB, 16.94 ± 19.93 dB, 12.63 ± 16.71 dB, 7.36 ± 15.28 dB, 5.27 ± 11.58 dB and 2.91 ± 12.44 dB, respectively. Three patients had complete recovery, 1 had partial recovery, 5 had slight recovery and 25 had no improvement. CONCLUSION: Hyperbaric oxygen utilised as a salvage therapy after failed corticosteroid therapy may be beneficial in some patients. Studies with more patients are needed.