Relationships between facial canal dehiscence and other intraoperative findings in chronic otitis media with cholesteatoma.

OBJECTIVE: We investigated the relationship between facial canal dehiscence and intraoperative middle ear and mastoid findings in patients operated on for cholesteatoma. METHODS: We examined retrospectively 334 patients who had been operated on for cholesteatoma in Izmir Katip Celebi University, Ataturk Research and Training Hospital, ENT Clinic, between April 1997 and April 2010. The patients were examined for facial canal dehiscence according to age, gender, side of the ear, surgery type, first or revision surgery, localization of the facial canal dehiscence, spread of the cholesteatoma, with the presence of lateral semi-circular canal (LSCC) fistula and any defect in the ossicle chain, and destruction in the posterior wall of the external auditory canal(EAC). RESULTS: Of the patients, 23.6% had facial canal dehiscence and detected most commonly in the right ear 28.9% and tympanic segment, 83.5%. Facial canal dehiscence was found to be 24.2-fold more common in patients with LSCC fistula and 4.1-fold more common in patients with destruction in the posterior wall of the (EAC). In patients located cholesteatoma in tympanic cavity+antrum and the tympanic cavity+all mastoid cells and with incus and stapes defect, increased incidence of dehiscence. Age, first or revision operation and canal wall down tympanoplasty (CWDT) or canal wall up tympanoplasty (CWUT) did not affect the incidence of dehiscence. CONCLUSIONS: That the likelihood of facial canal dehiscence occurrence is increased in patients with LSSC fistulas, destruction in the posterior wall of the EAC, or a stapes defect is important information for surgeons.

Evaluation of the protective effect of α-lipoic acid on cisplatin ototoxicity using distortion-product otoacoustic emission measurements: an experimental animal study.

The aim of our study was to determine the effectiveness of intratympanic α-lipoic acid injection as an otoprotective agent against cisplatin-induced ototoxicity in guinea pigs. Twenty-four adult male albino guinea pigs with normal hearing were divided into 4 groups. The guinea pigs received intraperitoneal cisplatin in group 1, intraperitoneal cisplatin and intratympanic α-lipoic acid in group 2, intratympanic α-lipoic acid in group 3, as well as intraperitoneal cisplatin and intratympanic saline in group 4. Distortion-product otoacoustic emission measurements were obtained for both ears at the following time points: before administration (baseline recording) and on day 3 (72 h later). In group 1 (cisplatin), significant deterioration was observed at all frequencies on day 3 (P < 0.05). In group 2 (cisplatin + α-lipoic acid), deterioration was observed at all frequencies on day 3; however, this deterioration did not reach a statistical significance (P > 0.05). In group 3 (α-lipoic acid), no significant difference was observed between baseline and day 3 (P > 0.05). In group 4 (cisplatin + saline), deterioration was observed at all frequencies on day 3; however, this deterioration did not reach a statistical significance (P > 0.05). Cisplatin-induced hearing loss in the guinea pigs may be limited to some extent by the concomitant use of α-lipoic acid. Dose-dependent changes in the possible effects of α-lipoic acid need further investigation. Future morphologic studies may contribute to expose clearly the protective effect of α-lipoic acid.

Results of decompression with middle cranial fossa approach or traumatic intratemporal fascial nerve injury.

OBJECTIVE: To present the results of the traumatic intratemporal facial nerve injury that have undergone facial nerve decompression by using middle cranial fossa (MCF) approach. STUDY DESIGN: A retrospective study SETTING: Tertiary referral center PATIENTS AND METHODS: In this study, 13 patients who developed facial paralysis due to temporal bone trauma and undergone decompression by using MCF approach in Department of Otorhinolaryngology of Izmir Katip Celebi University Research and Training Hospital between January 1993 and December 2012 were presented retrospectively. Patients were assessed in terms of side, etiology, fracture type, House-Brackmann (HB) grade, electroneuronography (ENOG), electromyography (EMG), hearing loss, operation time, and the region of the injury. RESULTS: The fracture was at the right side in 7 (53.8%) and at the left side in 6 patients (46.1%). The type of temporal bone fracture was longitudinal in 6 (46.1%), transverse in 2 (15.3%), and mixed in 5 patients (38.4%). Total axonal degeneration in EMG and ENOG were seen in all patients, who were HB grade 6 at preoperative assessment. Mean operation time was 30 days. The lesion in all patients was at the region of geniculate ganglion. There was conductive hearing loss in 7 patients (53.8%), sensorineural in 4 (30.7%), and mixed in 1 patient (7.6%); hearing was normal in 1 patient (7.6%). Seven patients (53.8%) improved to HB grade 2. CONCLUSION: In the light of the information obtained from HRCT, ENOG, and EMG, we believe that better results can be achieved with facial nerve decompression that is performed before 1 month, and geniculate ganglion region may be better controlled by MCF approach.

Postintubation laryngotracheal stenosis: assessing the success of surgery.

OBJECTIVE: This study evaluated the outcome in adult patients with laryngotracheal stenosis (LTS) and assessed the effect of procedures on their quality-of-life scores. METHODS: The study included 15 adult patients with LTS (11 males [73.3%], 4 females [26.7%]; mean age, 32 years [range, 10-52 years]) treated at the Department of Otolaryngology Head and Surgery Clinic, Izmir Atatürk Research Hospital, Turkey, from 1997 to 2008. Success of the surgery is evaluated by decanullation rate, Short form-36 (SF-36), and the Medical Research Council dyspnea scale. RESULTS: The etiology of the LTS was intubation related in 14 cases (93.3%) and idiopathic in 1 case. According to the Myers-Cotton classification, 2 (13%), 8 (54%), and 5 (33%) patients were at stages 2 to 4, respectively. Fourteen patients had a mean follow-up of 57 months (range, 24-256 months). The stenotic segment involved 1 to 3 cm (mean, 1.7 cm) of trachea, and 2 to 5 tracheal rings (mean, 3.1) were resected. Postoperative decannulation was achieved in 13 patients (86.6%). In the short form-36 questionnaire, all of the parameters except for "role-emotional" were found to be significant (P < 0.01). The Medical Research Council dyspnea scale assessment revealed a significant (P < 0.001) decrease postoperatively. CONCLUSIONS: Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected cases of advanced stenosis.

Synovial sarcoma of the infratemporal fossa with intracranial extension.

Synovial sarcomas (SS) account for 7-8% of soft-tissue cancers and 3-5% of all cases with head and neck involvement. Synovial sarcoma of the infratemporal fossa is very rare In this article, we report the fourth case of SS of infratemporal fossa and the first case with intracranial extension via the foramen ovale. A 31-year-old man admitted with a one-year history of intense pain in his right jaw. On physical examination, there was only hyperesthesia over the right mandible side. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a mass in the infratemporal fossa and intracranial extension from the foramen ovale. The mass was surgically removed en bloc. Postoperative pathological examination reported the mass as a biphasic-type synovial sarcoma. The patient who received postoperative chemoradiotherapy had no recurrent disease for one year. The patient is still being followed in our clinic.

[Giant osteoma with intracranial extension filling sinonasal cavity: a rare case]. / Sinonazal boslugu dolduran intrakraniyal uzanimli dev osteom: Nadir bir olgu.

Osteomas are the most frequently observed benign bone tumors of paranasal sinuses. Although they are generally detected by chance during radiological analyses, they may create severe complications after intracranial extension. While computed tomography findings play a key role to differentiate osteoma from other osseous lesions of paranasal sinus, magnetic resonance imaging identifies extension to surrounding structures and possible complications. Osteoma was detected in a 28-year-old female patient who admitted with complaints of headache and difficulty in breathing. Patient was operated after diagnosis; however, we were unable to remove the mass totally due to its location and size. In this article, we report, to our knowledge, the largest defined osteoma case in the literature to date, with ethmoid sinus origin, orbital, nasal cavity and intracranial extension, accompanied with distinctive computed tomography and magnetic resonance imaging findings.

Mucosal trauma induced apoptosis in guinea pig middle ear: comparision of hemostatic agents.

OBJECTIVE: The aim of this study is to compare the effects of the absorbable gelatin sponge (AGS), microporous polysaccharide hemospheres (MPH), and Ankaferd on wound healing after middle ear trauma and to evaluate their ototoxicity in an experimental guinea pig model. METHODS: Middle ear mucosal trauma was created in 21 healthy adult guinea pigs. MPH, Ankaferd, and AGS were applied into the right tympanic bulla of the guinea pigs (7 ears for each treatment modality). The left ears of the seven animals were used as the sham group. At the fourth postoperative week (28-30 days), the guinea pigs were decapitated. Apoptosis was investigated, and the expression of Bcl-xl, Apaf, p53, cytochrome 3, and caspase 3 were evaluated. RESULTS: The Ankaferd and AGS groups demonstrated significantly lower epithelial thickness, inflammation, and capillary dilatation than did the control group (p<0.001, <0.001, /0.001, <0.001/, 0.005, and 0.005, respectively). A statistically significant decrease in Bcl-xl staining was observed in the middle ears of animals treated with MPH (p=0.003). There was significantly higher caspase 3 expression in the Ankaferd and AGS groups than in the control group (p<0.001 and p=0.002, respectively). CONCLUSION: Light microscopy indicates that Ankaferd and AGS create less inflammation and increased caspase expression, which seems to induce inflammatory cell apoptosis. Ankaferd seems to be a promising hemostatic agent in otology.

Hearing loss effects of administering boric alcohol solution prepared with alcohol in various degrees on guinea pigs (an experimental study).

OBJECTIVE: To investigate the ototoxic effect of boric acid solution prepared with different degree of alcohol. METHODS: This study was performed on 28 young albino guinea pigs. After the animals divided four groups prior to the application of the solution an auditory brainstem response (ABR) test was applied to the each animal under general anesthesia. Their tympanic membranes perforated and test solutions were administrated to the middle ear through the perforation. On 15th day, ABR measurements were carried out and comparison was made with preadministration values. RESULTS: The degrees of hearing loss occurring as a result of the administration of 4% boric alcohol solutions prepared with 60° and 40° alcohol differed significantly (p < 0.001). CONCLUSION: It was established that 4% boric acid solution prepared with 60 alcohol affected hearing in guinea pigs more negatively and an increase in degree of alcohol also increased the ototoxicity of the boric acid solution.