Comparison of two different bone anchored hearing instruments.

PURPOSE: To compare the audiological performances of Turkey's most up-to-date bone conduction implant processors. METHODS: Twenty-six bone-anchored hearing instrument users, thirteen in each group, were evaluated for speech understanding in quiet and several signal-to-noise ratios. RESULTS: We noticed the differences at 0.5 and 1 kHz measurements in free field frequency specific test, aided SRT scores, non-adaptive and adaptive matrix test results for a few conditions created a statistically significant difference in favor of Baha-6®. CONCLUSIONS: Both processors offer positive gains to their users in noisy and silent conditions. However, the data showed statistically significant differences for some measurements that may be critical for patients in daily practice.

The role of serum salusin alpha and beta levels and atherosclerotic risk factors in idiopathic sudden hearing loss pathogenesis.

PURPOSE: The aim of this study was to investigate the importance of atherosclerosis in the pathogenesis of sudden hearing loss by evaluating the newly discovered markers, serum salusin-α and salusin-ß. We also aimed to evaluate atherosclerosis risk factors, such as lipid profile, smoking, body mass index, waist circumference and mean blood pressure of the patients. METHODS: Fifty-two patients diagnosed with sudden hearing loss (study group) and fifty healthy people (control group) were included in the study. Detailed history was taken from the patients and risk factors for atherosclerosis, such as smoking, body mass index, waist circumference, lipid profile, mean blood pressure and serum salusin-α and salusin-ß levels, were evaluated. The study group was divided into recovery group (subgroup I) and non-recovery group (subgroup II). RESULTS: The salusin-ß median value was found to be significantly higher in the study group compared to the control group (p < 0.05). The salusin-ß median value was found to be significantly higher in subgroup 2 and was found to be a poor prognostic factor (p < 0.05). CONCLUSION: From the results obtained in this study, it is thought that salusin-ß peptide is increased in patients with sudden hearing loss and it can be evaluated as a poor prognostic factor.

Comparison of the results of caloric and video head impulse tests in patients with Meniere's disease and vestibular migraine.

PURPOSE: To compare the results of video head impulse test (vHIT) and caloric testing (CT) in patients with vestibular migraine (VM) and Ménière's disease (MD) and to investigate the relationship between these two tests. METHODS: Patients with definite unilateral MD and VM were included in the study. All patients underwent both vHIT and CT. The vestibulo-ocular reflex (VOR) gains of lateral semicircular canals and saccadic waves in vHIT and the canal paresis factor for the CT were examined. RESULTS: CT was found abnormal in 39 (66.1%) patients with MD and in 17 (34%) patients with VM, while abnormal gain of the lateral canal was obtained in 23 MD (39%) patients and 9 (18%) VM patients. In all, 11.9% of patients with an abnormal vHIT had a normal CT, whereas 33.9% of those with an abnormal CT had a normal vHIT. CONCLUSION: Loss of VOR detected by caloric testing is more common and severe in MD than VM. Although vHIT is useful and can give complementary information, vestibular testing with the caloric test still seems more sensitive for detecting hVOR pathology.

Are neutrophil, platelet and eosinophil-to-lymphocyte ratio and red blood cell distribution width can be used for nasal polyposis?

INTRODUCTION: The aim of this study is to explore the relationship of neutrophil, platelet and eosinophil-to-lymphocyte ratios and red blood cell distribution width values with nasal polyposis, and whether this could be a predictive parameter that can be used for the severity and recurrence risk of the disease. METHOD: Neutrophil/lymphocyte, platelet/lymphocyte, eosinophil/lymphocyte ratios and red blood cell distribution width values were compared between nasal polyposis patients who were reviewed in a retrospective manner and the control group comparable for age and sex. Moreover, the nasal polyposis group was grouped for nasal polyposis severity and recurrence, and these subgroups were statistically compared, too. RESULTS: When the nasal polyposis patient group and the control group are compared, no statistically significant difference was found between two groups except for eosinophil/lymphocyte ratio. While only the difference between nasal polyposis severity and eosinophil/lymphocyte ratio is statistically significant, there was no parameter with statistically significant difference for recurrence. CONCLUSION: We think that caution should be exercised when using these new hematological parameters which can be affected by many factors for the presence, severity and recurrence risk of nasal polyposis, and literature data should be proven by conducting different and objective studies on this subject.

Comparison of Incidence and Severity of Chronic Postsurgical Pain Following Ear Surgery.

OBJECTIVES: Literature review shows a limited number of studies investigating chronic pain following ear surgeries. The effect of mastoidectomy on chronic postsurgical pain, however, has never been investigated. The present study investigates not only the incidence and severity of chronic pain following ear surgeries with and without mastoidectomy, but also predisposing diseases for pain. PATIENTS AND METHODS: The study was performed in a total of 150 patients who underwent tympanoplasty or tympanomastoidectomy through a retroauricular incision in a single tertiary health care center. During the routine postoperative 3rd-month examination, the patients were questioned for the presence and severity of chronic pain, as well as the diseases that might predispose the pain. RESULTS: The difference between the visual analog scale scores of the groups was not statistically significant. Comparison of pain character revealed that neuropathic pain is more prevalent in both the groups. Evaluating the relationship between concomitant diseases and chronic pain, it was observed that migraine, cervical pathology, and acute postsurgical pain were closely associated with chronic pain. CONCLUSION: It was demonstrated that mastoidectomy does not pose an additional risk for chronic postsurgical pain. However, patients with migraine, cervical pathology, and acute postsurgical pain are at risk for chronic postsurgical pain.

Assessment of the Factors That Affect the Anatomic and Functional Success of Cartilage Tympanoplasty in Children.

OBJECTIVES: Many factors may influence the surgical outcome of tympanoplasty in children, including age, the size and location of perforation, otorrhea, status of contralateral ear, surgical technique, and adenoid hypertrophy. This study aims to evaluate the outcomes of pediatric cartilage tympanoplasty and to assess the factors that affect the success of tympanoplasty in children. METHODS: Children with chronic otitis media who underwent tympanoplasty using cartilage as graft material were evaluated retrospectively. Patient age, gender, size and site of the perforation, status of the contralateral ear, preoperative and postoperative hearing levels, surgical technique, and postoperative complications were noted. RESULTS: Of the 72 patients included in the study, 27 were male and 35 were female. The average age was 13.22 ±â€Š2.64 and mean follow-up time was 18.4 ±â€Š8.62 months. Anatomic and functional success rates were 88.8% and 80.6%, respectively. Age, gender, and the status of the contralateral ear had no effect on surgical success rate. The mean preoperative and postoperative pure-tone averages were 33.2 6±â€Š10.37 and 21.00 ±â€Š13.25 dB, respectively. CONCLUSION: Anatomic and functional outcomes of cartilage tympanoplasty are quite satisfactory in pediatric patients. Chronic otitis media should be treated surgically as early as when patient cooperation is possible.

Somatoform disorders in patients with chronic subjective tinnitus.

This study aimed to investigate the correlation of psychiatric disorders with tinnitus and tinnitus handicap scores. A total of 30 patients and 30 otherwise healthy people were enrolled for the study. Somatoform disorder questionnaire SDQ-20 was filled in by both the study and the control group. Tinnitus handicap scores were filled in study group. Tinnitus handicap scores were 28.1 ± 19.8, and somatoform disorder questionnaire scores were 30.5 ± 7.3 in the tinnitus group. In the control group the somatoform disorder questionnaire scores were 25.4 ± 4.6. (1) We found a statistically significant difference between somatoform disorder questionnaire scores between groups (p < 0.05). (2) There was a statistically significant difference between tinnitus handicap scores and somatoform disorder questionnaire scores in study group (p = 0.0). The correlation between these tests was positively strong (R = 0.782). (3) There was no statistical difference between genders. We recommend investigating patients with long-lasting tinnitus for psychiatric comorbidity in relation to somatoform disorders in cooperation with psychiatric clinics.

Comparison of the anatomic and hearing outcomes of cartilage type 1 tympanoplasty in pediatric and adult patients.

As a graft material cartilage produces an excellent anatomical result with a low risk of re-perforation. However, there is a controversy among surgeons regarding its sound conduction properties, due to the thickness and stiffness of the cartilage. The aim of this study was to evaluate results of cartilage type I tympanoplasty and to compare anatomic and audiologic results in pediatric and adult patients. Patients with chronic otitis media who underwent cartilage type I tympanoplasty were evaluated retrospectively. Patient age, gender, pre and postoperative hearing levels, surgical technique and postoperative complications were recorded. Hearing outcomes of the patients were measured with tonal audiometry by comparing the pre and postoperative hearing threshold calculated at 0.5, 1, 2, and 4 kHz. Graft success rates and hearing outcomes of the pediatric and adult patients were compared. Of the 136 patients included in the study, 58 were male and 78 were female. The average age was 25.03. Forty-five patients were ≤16-year old and 91 patients were >16-year old. Intact graft was determined in 41 of 45 pediatric patients and 85 of 91 adult patients at the last follow-up visit. The overall graft success rate was 92.6 %. The mean pre and postoperative pure-tone average was 34.8 ± 8.5 and 23.4 ± 9.1 dB in adult patients, and 30.6 ± 7.7 and 17.8 ± 7.8 dB in pediatric patients. Cartilage graft provides a quite satisfactory anatomical result and perfect stability. Hearing outcomes of cartilage tympanoplasty are also acceptable in both children and adult patients.

Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate.

The aim of the study was to investigate the relationship between nasal septal deviation and the middle turbinate hypertrophy using computed tomography. In this retrospective analysis, we examined 77 patients with nasal septal deviation. The mucosal and bone structures of the middle turbinate and the angle of the septum were measured using radiological analysis. Measurements of the middle turbinate on the convex side were compared to those on the concave side. Measurements of the bony and mucosal structure area of the middle turbinate were significantly greater than those on the concave side. The dimensions of medial mucosa thickness and bone thickness were not significantly different between the convex and concave sides. No significant correlation was found between the angle of deviation and other parameters. The present findings suggest that compensatory middle turbinate hypertrophy was caused both by conchal bone growth and mucosal hypertrophy in patients with nasal septal deviation.

The comparison of the viability of crushed, morselized and diced cartilage grafts: a confocal microscopic study.

To compare the cellular viability of diced, crushed, and morselized cartilage used in nasal surgeries. In this study, cartilage was extracted from the ears of seven New Zealand rabbits and was subsequently either diced, crushed or morselized to an amorphous state, or left unmodified. The four types of grafts were then implanted in the back regions of the rabbits. After 3 months, the cellular viability from four groups was compared to a control group using confocal microscopy. Analysis of the data obtained from the enumeration of live cells showed no statistically significant difference between the unmodified graft group and the control group. The diced, crushed, and morselized cartilage groups did show a statistically significant difference in terms of live cell count with the highest number of live cells in diced cartilage group. A statistically significant decrease in live cell count was detected in crushed cartilage group. Our study shows that the viability of cells in diced cartilage grafts is greater than those in crushed or morselized cartilage grafts.

A novel method for nasal dorsal reconstruction: permanent fixation using Kirschner wire-guided hidden sutures.

BACKGROUND: In this study, we aimed to present a novel application and use of Kirschner wire-guided suturing that is less invasive and allows permanent fixation for nasal dorsal reconstruction. METHODS: A total of 23 patients, who underwent surgery between 2009 and 2013, were included in this study: 19 with saddle nose deformity and 4 patients with keystone area damage, or collapse of the dorsal nasal support during primary septoplasty or rhinoplasty. The patients were asked to fill out a nasal obstruction symptom evaluation (NOSE) scale preoperatively and at the postoperative sixth month to assess breathing quality. The patients were followed up for complications such as nasal dorsal contour irregularity, dorsal collapse, as well as graft malposition and infections. The results of the surgeries were assessed on the basis of preoperative and postoperative examinations, septal support test, NOSE scale results, and photographic comparison. RESULTS: The mean (SD) NOSE scales were 78.91 (10.09) and 30.48 (10.71) in the preoperative and postoperative periods, respectively. The difference of mean NOSE scale was statistically significant (P < 0.001). None of the patients experienced nasal dorsal collapse or graft malposition. Two patients had nasal dorsal irregularity complaints owing to inadequate costal cartilage edge beveling. None of the patients had complications of suture reaction, suture visibility, or suture extrusion. All of the patients stated that they were happy with the cosmetic outcome. CONCLUSIONS: Permanent sutures introduced through channels made with the Kirschner wire provide a less invasive, cosmetically pleasing, and functional solution, promising more reliable results in the long term.

Bifid inferior turbinate: a report of two cases.

Nasal turbinates are functionally important structures which extend from the lateral nasal walls to the nasal cavity. Lateral nasal wall anomalies are usually asymptomatic lesions which are incidentally detected. The most common variation of the lateral nasal wall is the pneumatization of turbinates. Anatomical variations of paranasal structures may present confusing intranasal landmarks. This may cause challenges in endoscopic sinus surgery. Bifid inferior turbinate is an extremely rare condition. In this article, we present two cases with bifid inferior turbinate. This variation should be kept in mind as a rare cause of nasal obstruction.

Prevalence of allergic fungal rhinosinusitis among patients with chronic rhinosinusitis with or without nasal polyposis who underwent endonasal sinus surgery in northwestern Turkey.

OBJECTIVES: This study aims to evaluate the prevalence of allergic fungal rhinosinusitis in chronic rhinosinusitis patients in the northwest of Turkey. PATIENTS AND METHODS: Eighty-seven patients diagnosed with chronic rhinosinusitis and who were planned endonasal sinus surgery were enrolled in this prospective study. Patients were evaluated by detailed clinical examination, computed tomography, skin test against allergens, total serum immunoglobulin E (IgE) antibody, fungal-specific IgE antibody, and histopathologic and mycologic monitoring. RESULTS: Fungal elements showing tissue invasiveness were detected in only four patients. These patients had specific IgE against Aspergillus fumigatus (4.6%). Skin tests were positive for at least one allergen in 16 patients (18.3%). CONCLUSION: None of the patients met diagnostic criteria for allergic fungal rhinosinusitis. This result may be due to the diversity in disease prevalence based on geographical location or diagnostic methods.

Submandibular ectopic thyroid with normally located thyroid gland.

Ectopic thyroid is a rare developmental anomaly of the thyroid gland which is defined as the presence of thyroid tissue at a site other than the pretracheal area. Nearly 1 to 3% of all ectopic thyroids are located in the lateral neck. Simultaneous submandibular ectopic thyroid tissue presenting with a functional orthotopic thyroid gland is extremely rare. In this article, we report a 37-year-old female case admitted to our clinic with a complaint of swollen neck in whom ultrasonography revealed submandibular ectopic thyroid tissue presenting with an orthotopic thyroid gland.

[Postoperative use of antibiotics in septoplasty cases: is it really necessary?]. / Septoplasti olgularinda ameliyat sonrasi antibiyotik kullanimi: Gerçekten gerekli mi?

OBJECTIVES: This study aims to investigate the efficacy of postoperative antibiotic use in the prevention of the surgical site infection. PATIENTS AND METHODS: Eighty patients who underwent septoplasty in our clinic between July 2012 and September 2012 were followed. Forty of them received preoperative antibiotic prophylaxis and postoperative oral antibiotics (group 1). The other 40 received only preoperative antibiotic prophylaxis (group 2). The patients were assessed at the time of removing packings and postoperative first and second week in terms of infection criteria; endoscopic examination was performed and complete blood counting, and C-reactive protein (CRP) levels were studied. Fifteen patients in each group who completed their follow-up were included in the study. RESULTS: Two patients receiving postoperative antibiotics in addition to the prophylaxis developed infection during follow-up. No infection was seen in the prophylaxis group. CONCLUSION: According to the comparison of the two groups, we conclude that there is no need to use postoperative antibiotics to prevent surgical site infections.

Nasal fractures: is closed reduction satisfying?

OBJECTIVE: This study aims to evaluate the efficacy of closed reduction and the effects of timing and fracture types on patient satisfaction. METHODS: Only patients with isolated nasal fractures were included in the study. Patients with additional maxillofacial fractures and patients whose application time to our clinic was more than 10 days after the trauma were excluded. Patients were classified into 5 types according to their fracture. All patients underwent closed reduction and external fixation under local anesthesia. Patients were asked about their satisfaction in a survey at 28th day and sixth month after the surgery. Patients were divided into groups according to fracture type and intervention time, and the results of the survey were evaluated. RESULTS: Of the 43 patients included in the study, 38 were male, 5 were female, and the average age was 24.9. The average intervention time of the patients was 5.44 days. Twenty-eight (65%) of 43 patients were satisfied with the result, whereas 15 (35%) patients were not happy with their operation. In a comparison of patient satisfaction rates according to fracture type, the mild fracture group had a higher satisfaction rate compared to the severe fracture group. CONCLUSION: Closed reduction is an easy and sufficient treatment for nasal fractures, especially for mild nasal fractures. Early intervention raises the patient satisfaction rate.

Effects of structured exercise program on severity of dizziness, kinesiophobia, balance, fatigue, quality of sleep, activities of daily living, and quality of life in bilateral vestibular hypofunction.

BACKGROUND: A minimal number of studies have documented the impact of Vestibular rehabilitation (VR) on the recovery rate of patients with bilateral vestibular hypofunction (BVH). OBJECTIVE: The purpose of this study was to investigate the effectiveness of structured VR programs on severity of dizziness, kinesiophobia, balance, fatigue, quality of sleep, activities of daily living (ADL) and quality of life (QoL) in subjects with chronic BVH. METHOD: Twenty-five participants diagnosed with BVH were included in the study. A structured VR program was applied in 50-minute sessions once a week and as a home exercise program 3 times a day over 8 weeks. Participants were evaluated for severity of dizziness with the visual analog scale, for kinesiophobia with the tampa scale of kinesiophobia, for balance with the Semitandem, tandem, and standing tests, for quality of sleep with the Pittsburgh sleep quality index, for ADL with the vestibular disorders activities of daily life, for QoL with dizziness handicap inventory and for fatigue with the fatigue severity scale at the baseline (T1), at 4th week (T2), 8th week (T3), and 20th week (T4) after study started. RESULTS: Significant difference in terms of Tandem Test and 1 Leg Stand Test was found in favor of T3-T4 Period (P < .05). There were significant improvements in terms of vestibular disorders activities of daily life, tampa scale of kinesiophobia, Pittsburgh sleep quality index and dizziness handicap inventory in favor of the T3 to T4 Period (P < .05). Significant difference in terms of visual analog scale was found in favor of T2 Period (P < .05). CONCLUSIONS: A twelve-week structured VR program may enhance severity of dizziness, kinesiophobia, balance, quality of sleep, ADL and QoL in participants with chronic BVH.

Effect of Bioabsorbable Poly (dl-Lactide ε-Caprolactone) on Healing of Experimentally Injured Acute Traumatic Middle Ear Mucosa Damage.

BACKGROUND: Postoperative adhesion is an important complication after middle-ear surgeries. Although many materials have been tried to prevent this complication, the use of Poly (dl-lactide ε-caprolactone) as an anti-adhesive material after middle-ear surgery has not yet been reported. The aim of this study was to evaluate the anti-adhesive effect of poly (dl-lactide ε-caprolactone) on the ears of rats with middle-ear mucosa damage. METHODS: In our study, 14 Wistar albino rats and 28 ears in total were used. The rats were randomly divided into 4 groups. Middle ear mucosa damage was performed in all groups with a transcanal approach under otomicroscopy in sterile conditions. The effects of poly (dl-lactide ε-caprolactone), silicone sheet, and absorbable gelatin sponge were compared histologically with the secondary healing group. In addition, hearing evaluation was performed before the procedure and on the 28th postoperative day. RESULTS: No significant difference was observed in transient otoacoustic emission and distortion product otoacoustic emissions tests performed before and after the surgical procedure when the groups were compared. While adhesion was observed in the tympanic membrane in the absorbable gelatin sponge group, no adhesion was observed in the other groups. In the absorbable gelatin sponge group, increased fibroblastic activity, inflammation, and neovascularization were observed in the middle-ear mucosa. No significant difference was observed in silicone sheet, poly (dl-lactide ε-caprolactone), and control groups in terms of fibroblastic activity, inflammation, and neovascularization. CONCLUSION: It can be concluded that absorbable poly (dl-lactide ε-caprolactone) is nonototoxic and biocompatible with the rat's middle ear cavity by short-term evaluation.

Glomus tumor of the nasal vestibulum: a rare clinical presentation.

Glomus tumor is an uncommon benign tumor rising from the glomus bodies. It is most often found on limbs and rarely involve the head and neck. In this report, we present the 31st documented case of a intranasal glomus (nasal vestibular) tumor, an extremely rare localization.