Different approach for surgery of stapes: Comparison microscopic and endoscopic approach.

OBJECTIVE: This study aimed to discuss the different surgical approach, functional hearing results, which are applied to patients operated with a diagnosis of otosclerosis in our clinic. METHODS: This study includes 92 ears of 84 patients who were operated with the diagnosis of otosclerosis. Air bone gap was calculated before and after the operation in all patients. In addition, endoscopic and microscopic methods can be compared and statistically tested whether there is a difference in air bone gap averages and surgical success. Of the 92 ears operated, 56 were right (61%) and 36 were left (39%). Otosclerosis was detected bilaterally in 61 patients (73%) and unilaterally (27%) in 23 patients. The duration of follow-up ranges from 6 month to ten years, on average 28 months. RESULTS: In the microscopic operation group, the air pathway measurement was mean 55.58 dB preoperatively and mean 38.42 dB postoperatively, with a mean decrease of 17.16 dB determined. The decrease between the preoperative and postoperative air pathway values was determined to be statistically significant (t:7.20, p < 0.001). In the microscopic operation group, the air-bone gap value was mean 30.50 dB preoperatively and fell by 15.90 dB to 14.60 dB postoperatively. In the endoscopic group, the air-bone gap value was mean 32.32 dB preoperatively and fell by 13.51 dB to 18.81 dB postoperatively. CONCLUSIONS: Stapes surgery is a successful method with high success rate and low complication rates in the treatment of otosclerosis. The success rate of endoscopic and microscopic stapes surgery is similar. However, endoscopic stapes surgery is specific and difficult otological surgery that must be performed by surgeons specialised on this subject.

Oval Window Temperature Changes in an Endoscopic Stapedectomy.

OBJECTIVES: Following the initial use of endoscopes in otology, the pros and cons of these instruments have been questioned increasingly. These instruments cause an increase in temperature that needs to be investigated. In this study, the authors aimed to investigate the temperature increase caused by endoscopes and light sources in the perilymph by performing a stapedotomy in an animal model under anesthesia. STUDY DESIGN: The study was performed in a guinea pig model. METHODS: In the animal model, a simulated otologic stapes surgery was performed at room temperature. The body temperatures of the guinea pigs were monitored; the temperature increase caused by the 0-degree rigid endoscopes with diameters of 3 and 4  mm as well as the light sources, including halogen, light-emitting diode (LED), and xenon lamps, were monitored following the stapedotomy to measure and document the continuous temperature increase in the perilymph using sensors placed at the oval window. RESULTS: Rigid endoscopes cause a temperature increase in the tympanum regardless of their diameter when used with xenon and halogen light sources. The LED light caused a relatively small temperature increase. CONCLUSIONS: The endoscopic instruments used in the stapes operation caused a temperature increase in the oval window. The authors concluded that this heat could easily be transmitted to the cochlea by the perilymph, which has obstructed contact with the outer environment following stapedomy, resulting in neurosensorial damage.

The effect of extracorporeal shock wave lithotripsy on the hearing.

OBJECTIVE: To investigate the effects of extracorporeal shockwave lithotripsy on hearing. METHODS: The study group consisted of 34 patients with urinary lithiasis on whom ESWL was applied in a single course. Patients with normal hearing levels were included in the study. Conventional audiometry and transient evoked otoacoustic emissions were recorded before the application of the procedure and thirty minutes afterwards. RESULTS: A total of 68 ears of 34 patients were evaluated. Of those, 15 (44.1%) patients were male and 19 (55.9%) were female. The average age was 31.47 +/- 15.62 (range, 10-62 years). There was no statistically significant variation, according to the data obtained from the pure tone average threshold of the shockwave procedure on the otoacoustic emission test. CONCLUSION: The results of the study indicate that the risk to the hearing of patients exposed to lithotripter noise is negligible and, therefore, ESWL is a safe procedure.

A rare case of petrous apex osteoma.

Osteomas are the most common tumours of the cranial vault and facial skeleton. Temporal bone osteoma is a rare entity. An osteoma arising from the petrous apex is extremely rare. We present a case of osteoma arising from the petrous apex followed by a discussion of the etiology, presentation, and radiologic findings.

Chorda Tympani nerve injury during tympanoplasty. Comparison of endoscopic and microscopic methods.

PURPOSE: Iatrogenic injury of the chorda tympani nerve (CTN) is a well-recognized complication of middle ear surgery The aim of the present study was to compare CTN injury occurring as a result of type 1 tympanoplasty performed using microscopic and endoscopic methods. METHODS: A retrospective study was conducted at our institution on patients diagnosed with chronic otitis and then treated with type 1 tympanoplasty surgery between January, 2013 and January, 2014 .The patients were divided into two groups; group 1 consisted of patients who underwent endoscopic tympanoplasty and group 2 consisted of patients who underwent microscopic tympanoplasty. At follow-up 3, 6 ,and 12 months after surgery patients were asked to complete a questionnaire that enquired about symptoms of CTN injury: changes in taste sensation, tongue numbness. and dry mouth. RESULTS: There were 66 patients (33 males, mean age 30.4 ± 8.14 years (range: 8-56 years)) There were 25 patients in group I (endoscopic tympanoplasty) and 41 patients in group 2 (miscroscopic tympanoplasty). A total of 11 (16.6%) patients reported symptoms related to CTN damage: 1 (4%) patient in group and 10 (24%) patients in group 2. A metallic taste in the mouth was the most-common symptom, noted by 7 patients(63.6%), 1 (4%) in group 1 and 6(14.6%) in group 2. Ageusia/hypogeusia was reported by 4 patients (37.4%) all in group 2 Tongue numbness occurred in 2 patients (4.8%) in group 2. No patients had xerostomia. CONCLUSIONS: Type I tympanoplasty performed with an endoscopic technique is minimally invasive,and is associated with less CTN manipulation and as a consequence less iatrogenic injury to the CTN KEY WORDS: Chorda Tympani Nerve, Endoscopic Tympanoplasty, Microscopic Tympanoplastytype 1 Tympanoplasty.

Nostril stenosis after undue power application of electric cauterization used in hypertrophy of inferior turbinate.

Nostril stenosis is an uncommon deformity with a variable aetiology. It may be either congenital or acquired. The causes of the acquired form includes trauma, infection and iatrogenic injury to the vestibular skin. Previous surgery including septoplasty and rhinoplasty, overzealous use of chemicals, laser, electrocauterization and traumatic placement of nasal packing to control epistaxis contribute significantly to the development of vestibular stenosis. Electrocauterization for inferior concha hypertrophy is a simple procedure and is frequently used in otolaryngeology-head and neck surgery. If enough attention is not paid during the operation, it may cause severe nasal obstruction and an aesthetic deformity which cannot be repaired easily. Various techniques have been described for repair of this stenotic segment but correction is difficult due to tendency of wound-contracture and recurrence. We present a case of a 58-year-old male patient complaining of nasal obstruction and an aesthetic deformity who had sought treatment for stenosis of the left nostril of 6 months duration. Previously, the patient had undergone septoplasty and electrocauterization for inferior turbinate hypertrophy.

Single Dose Topical Application of Clotrimazole for the Treatment of Otomycosis: Is This Enough?

BACKGROUND AND OBJECTIVES: To determine the efficacy of filling the external auditory meatus with 1% clotrimazole at a single visit for the treatment of otomycosis. Subjects and. METHODS: This prospective study included 40 patients who were referred to our clinic with complaints of ear itching, pain, and fullness, and were diagnosed with unilateral otomycosis. After cleaning the mycotic hyphae from the external auditory meatus, the ear canal was filled with 1% clotrimazole, using an intravenous catheter and syringe. The patients received follow-up examinations on post-treatment days 7, 15, and 45. RESULTS: The follow-up otomicroscopic examinations revealed that 95% of the ear canals were entirely clean and that all symptoms had resolved. The post-treatment scores of pain, aural fullness and itching were significantly lower than the pre-treatment scores (p<0.01). CONCLUSIONS: Filling the external auditory meatus with 1% clotrimazole at a single visit is an easy, efficient, and cost-effective treatment for otomycosis. Additionally, high patient compliance makes this treatment superior to long-term topical therapy.

A mean red blood cell volume loss in tonsillectomy, adenoidectomy and adenotonsillectomy.

OBJECTIVE: To calculate a mean red blood cell volume (RBCV) loss per kilogram (kg) in adenoidectomy, tonsillectomy, and adeno-tonsillectomy. MATERIALS AND METHODS: Pre- and post-operative complete blood cell count, and pre-operative clotting studies of 144 patients were measured. Total blood volume (75 or 70 ml/kg), pre- and post-operative RBCV (hematocritxtotal blood volume), RBCV loss, per kg RBCV loss and per cent RBCV loss were calculated. RESULTS: There was significant differences between pre- and post-operative RBCV, Hb, and Htc values for tonsillectomy, adenoidectomy and A&T groups, respectively (p<0.001 for all groups). We found a mean RBCV loss of 33 ml (5.56% of total RBCV) for adenoidectomy, 128 ml (10.63% of RBCV) for tonsillectomy and 60 ml (10.71% of RBCV) for A&T. RBCV loss per kg was 1.57+/-1.29 for adenoidectomy, 2.96+/-1.91 for adeno-tonsillectomy, and 3.02+/-1.66 for tonsillectomy. CONCLUSION: According to us, for management of the patients, knowledge of a mean nature loss of RBCV per kg is important because bleeding seems to be unavoidable in the intra-operative or maybe post-operative period in these operations.

Audiological findings in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease. The aim of this investigation was to study the relationship between AS and hearing loss. This study compared 28 patients with AS with 23 age-matched controls. All subjects underwent ENT examination, audiological and acoustic immittance measurements, and auditory brainstem response (ABR) tests. Sensorineural hearing loss was found in 28.6 per cent of the AS patients and in 4.35 per cent of the control group. For hearing levels at 250-500 Hz and 4000-8000 Hz, there was a statistically significant difference between the two groups. Acoustic reflex was not obtained in both ears of four patients and the left ear of one patient. There was a correlation between increase of tympanic volume and limitation in neck movement, between extension of 1-3 interpeak latency and limitation in the neck movement. In conclusion, AS affects the inner ear more than the middle ear.

Treatment of Large Tympanic Membrane Perforations: Medial to Malleus Versus Lateral to Malleus.

The perforation size affects the success of tympanic membrane (TM) reconstruction, in addition to the surgical technique used. Large TM perforations present a surgical challenge. The perforation size has been reported to be a prognostic factor, and poorer results are obtained with large versus small perforations. We aimed to evaluate patients who had undergone tympanoplasty for large perforations at our clinic using either the underlay or over-underlay technique and to compare the results in terms of re-perforation, retraction, lateralization, and improvement of hearing. Of 302 patients with chronic otitis media, 114 who had a perforation that involved over 50 % of the pars tensa were enrolled in the study. The underlay technique was used in 61 patients, and the over-underlay technique in 53 patients. In the underlay group, the preoperative mean perforation size was 30.11 ± 5.35 mm(2) (range 20.00-52.00 mm(2)) (n = 61). In the over-underlay group, the preoperative mean perforation size was 31.41 ± 8.65 mm(2) (range 22.00-48.00 mm(2)) (n = 53). The graft success rate of tympanoplasty performed using the underlay technique was 89.1 % in 61 patients. Seven (10.9 %) patients had graft failure. The graft success rate with the over-underlay technique in 53 patients was 90.5 %. Five (9.5 %) patients had graft failure in this group. Three graft lateralizations (5.6 %) and two retractions (3.8 %) were observed at 12 months postoperatively in the over-underlay group. However, in the underlay group, no graft lateralization but five retractions (8.2 %) were observed at 12 months. The graft-take rates and hearing improvement results in both groups were successful and compatible with those in the literature.

Hemostatic efficacy of a traditional medicinal plant extract (Ankaferd Blood Stopper) in bleeding control.

The aim of this study is to assess the in vivo hemostatic effect of Ankaferd Blood Stopper (ABS) on rats using a tail bleeding model. Wistar rats were randomized into 4 groups of 9 each: group 1, control, no pretreatment, irrigated with saline; group 2, no pretreatment, irrigated with ABS; group 3, control, heparin pretreatment, irrigated with saline; and group 4, heparin pretreatment, irrigated with ABS. To control bleeding, compressive dressings were placed after instilling 1 mL of either ABS or saline to the bleeding area. Without heparin pretreatment, ABS shortened hemostasis time by 1.57 minutes and reduced the amount of bleeding by 0.85 g. With heparin pretreatment, ABS shortened hemostasis time by 3.29 minutes and reduced the amount of bleeding by 1.32 g. The ABS was more effective than saline irrigation for treating tail tip bleeding in rats, with or without heparin pretreatment, while also using a compressive dressing.

[An unusual tracheobronchial aspiration in a patient with total laryngectomy]. / Total larenjektomili bir olguda ilginç trakeobronsial aspirasyon.

Laryngectomized patients use a variety of tools for tracheostomy cleaning, some of which may vary greatly depending on their sociocultural status. The use of inappropriate tools may lead to complications. A seventy-eight-year-old male patient who had a history of total laryngectomy 12 years ago presented with difficulty in breathing and sputum production. Tracheoscopy showed two nails and chest x-rays showed one nail that had been aspirated during stromal care. The three ordinary nails were removed under general anesthesia. This case illustrates the need for detailed and consistent education of laryngectomy patients on proper stomal cleaning and on the associated complications that may arise from the use of inappropriate tools.

Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps.

OBJECTIVE: Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs. METHODS: One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n=60) consisted of patients with NPs, and group 2 (n=60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels. RESULTS: There were no statistical differences in gender, age and biochemical values between two groups (p>0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p<0.001). CONCLUSION: As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.

The efficacy of Ankaferd Blood Stopper in heparin-induced hemostatic abnormality in a rat epistaxis model.

OBJECTIVE: To assess the in vivo hemostatic effect of Ankaferd Blood Stopper (ABS). STUDY DESIGN: An experimental study of an animal anterior epistaxis model. SETTING: A tertiary care university hospital. SUBJECTS AND METHODS: Wistar rats were randomized into 4 groups of 7 each: group 1, control, no pretreatment, irrigated with saline; group 2, no pretreatment, irrigated with ABS; group 3, control, heparin pretreatment, irrigated with saline; and group 4, heparin pretreatment, irrigated with ABS. In all groups, a standardized rat epistaxis model was obtained by cutting the anterior nasal septal mucosa. To control bleeding, compressive dressings were placed after instilling 1 mL of either ABS or saline to the bleeding area. The hemostasis time and amount of nasal bleeding were measured in all groups to compare the treatments without and with ABS. RESULTS: Without heparin pretreatment, ABS shortened the hemostasis time by 1.57 minutes (P = .003) and reduced the amount of the bleeding by 0.35 g (P = .006). With heparin pretreatment, ABS shortened the hemostasis time by 2.86 minutes and reduced the amount of the bleeding by 0.49 g (both P = .002). CONCLUSION: ABS irrigation was more effective than saline irrigation for treating anterior epistaxis hemostasis in animals using a compressive dressing with or without heparin pretreatment.

The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy.

OBJECTIVE: To evaluate the efficacy of Ankaferd Blood Stopper (ABS) in the control of intraoperative and postoperative bleeding in adenoidectomy. METHODS: In total, 90 patients underwent traditional cold steel adenoidectomy and were then randomized to receive ABS or 0.9% physiological saline solution to obtain hemostasis. Objective data collected included time of operation and blood loss during operation. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal and ease of operation. RESULTS: In a comparison between patients in the ABS group (n = 46) and the control group (n = 44), those in the ABS group had significantly shorter operation times (9.11 ± 1.02 vs. 13.16 ± 3.96 min; p < 0.001) and less blood loss during the operation (20.19 ± 8.59 vs. 25.48 ± 12.96 ml; p ≤ 0.05) and a shorter hemostasis time (3.83 ± 0.8 vs. 5.82 ± 1.67 min; p < 0.001). Regarding hemorrhage after tampon removal, 40 patients (87%) in the ABS group and 17 patients (38.6%) in the control group did not suffer from hemorrhage (p < 0.001). Regarding ease of hemostasis, 40 patients (87%) in the ABS group experienced very easy or easy hemostasis while 26 patients in the control group did so (59.1%; p = 0.004). Patients in the ABS group returned to a regular diet earlier and had less use of analgesics at 7 days postoperatively. Use of electrocautery was less in the ABS group than in the control group (10.9 vs. 40.9%; p = 0.001). CONCLUSIONS: The side on which ABS was used showed significant differences in hemostasis time, blood loss, and ease of hemostasis. ABS appears to be safe and effective; it decreases intraoperative bleeding and reduces operating time when compared to traditional hemostasis methods after curette adenoidectomy.

Primary hydatid cyst: an unusual cause of a mass in the supraclavicular region of the neck.

UNLABELLED: Hydatid disease, also known as echinococcosis or hydatidosis, is an infectious disease caused by the cestode Echinococcus. Echinococcus granulosus is the most common Echinococcus species affecting human beings. It may affect any organ and tissue in the body, in particular the liver and lung. Musculoskeletal or soft tissue hydatidosis accounts for about 0.5% 5% of all echinococcal infections in endemic areas, and is almost always secondary to the hepatic or pulmonary disease. Even in regions where echinococcosis is endemic, hydatidosis of cervicofacial region is extremely rare. Herein, we present exceptionally rare case with an unusual localization of primary hydatid cyst in the left supraclavicular region of the neck. KEYWORDS: Hydatid cyst; Supraclavicular region; Neck; Unusual localization.