Transcanal Endoscopic Management of Middle Ear Paragangliomas.

OBJECTIVE: To evaluate the clinical and audiological outcomes of transcanal endoscopic resection of middle ear paragangliomas. STUDY DESIGN: Retrospective multicenter study. SETTING: Tertiary referral center and private otology clinic. PATIENTS: Patients who underwent transcanal endoscopic surgery between January 2015 and September 2020. INTERVENTIONS: Transcanal endocope-assisted resection of middle ear paragangliomas. MAIN OUTCOME MEASURES: Demographic data. RESULTS: Twenty-three patients (2 men, 21 women) with a mean (standard deviation [SD]) age of 50.5 (11.8) years and stage 1 or 2 disease were included in the study. The mean follow-up time was 2.7 years (range, 1-5 yr). Preoperatively, the mean (SD) air-conduction threshold was 33.8 (17.9) dB, and the mean (SD) air-bone gap was 13.1 (13.9) dB. Postoperatively, the mean (SD) air-conduction threshold was 25.7 (10.2) dB, the mean (SD) air-bone gap was 6.3 (6.1) dB. The mean (SD) hospital stay was 27.7 (9.9) hours. No tumor regrowth was detected on magnetic resonance imaging during postoperative follow-up. CONCLUSIONS: Endoscopic transcanal tumor resection is effective and feasible in the treatment of stage 1 and 2 tumors and is associated with short operative time, low risk of perioperative and postoperative complications, and rapid discharge.

Effects of Cochlear Implantation on Tinnitus and Depression.

INTRODUCTION: Tinnitus is prevalent in 66-88% of cochlear implant users. The reason for this high prevalence is that hearing impairment is the most common cause of tinnitus. OBJECTIVE: This study aims to determine the effect of cochlear implant and to compare the severity of tinnitus and depression in adult cochlear implant users with tinnitus. METHODS: Patients diagnosed with tinnitus filled out the Tinnitus Handicap Inventory and the Beck Depression Inventory during CI candidate evaluation. The audiological follow-up in the present study included only patients suffering from tinnitus before the cochlear implant surgery. This study included only patients who had tinnitus handicap inventory and Beck Depression Inventory clinical records pre- and postoperatively, including 23 adult cochlear implant users (13 males and 10 females) aged 18-76 years. RESULTS AND CONCLUSION: There was a statistically significant decrease in the severity of tinnitus and depression after cochlear implant. As the participants' tinnitus level and grade decreased, their depression levels also decreased. Depression levels decreased after the use of a cochlear implant compared to before cochlear implantation. Cochlear implantation is currently used only for hearing restoration. However, cochlear implantation may be used in rehabilitation for tinnitus in patients with severe hearing loss and in tinnitus patients. In addition cochlear implantation can be a depression rehabilitation method by reducing tinnitus.

Investigating the effects of subthalamic Nucleus-Deep brain stimulation on the voice quality.

Introduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson's patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice.Materials/methods: A total of 12 patients, (8 male-4 female) with an age average of 58.8 ± 9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6 months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients' voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed.Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels.Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.

Assessment of inflammatory markers in otosclerosis patients.

INTRODUCTION: Otosclerosis is an idiopathic disease characterized by new bone formation in foci of the human otic capsule. It is more common in Caucasian populations; affecting females twice as often as males. Its etiopathogenesis has not yet been fully elucidated. OBJECTIVE: The aim of this study was to investigate the relationship between otosclerosis and white blood cell and thrombocyte counts, mean platelet volume, neutrophil lymphocyte ratio, and the platelet lymphocyte ratio. METHODS: This retrospective case-control study was conducted in the outpatient clinic Mustafa Kemal University, in the department of otolaryngology, between 2015 and 2018. A total of 30 patients with an established diagnosis of otosclerosis were compared to a control group of 30 healthy subjects, matched for age, gender and body mass index. The white blood cell, thrombocyte, mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio values were calculated for all participants. RESULTS: There was no statistically significant difference between the groups with respect to age, gender, or body mass index, or for the mean neutrophil lymphocyte ratio, platelet lymphocyte ratio, white blood cell, or thrombocyte values (p>0.05). A statistically significant difference was determined between the groups for the mean platelet volume values. The mean platelet volume values were lower in the otosclerotic patients (p=0.047). CONCLUSION: These results show that neutrophil lymphocyte ratio, platelet lymphocyte ratio, white blood cell and thrombocytes should not be used to predict otosclerosis, but suggest that mean platelet volume may be a negative predictive marker.

Evaluation of Hearing and Balance Functions of Patients with Sickle Cell Anemia.

INTRODUCTION: Sickle cell anemia is a disease characterized by a wide vaso-occlusive incident from micro-vascular incident to muscularactivity. The cochlear function can also get affected by this vaso-occlusion. OBJECTIVE: It is aimed at determining what kind of effects sickle cell anemia has on hearing and balance system. METHODS: This study has been conducted on 46 patients with sickle cell anemia and 45 healthy individuals. For all participants, their pure tone hearing thresholds and videonystagmography (VNG) findings have been determined in 17 frequencies between 125-16.000 Hz. RESULTS: All hearing thresholds between 125 and 16,000 Hz, pure tone averages of patients with sickle cell anemia have been found statistically significant to be higher than the corresponding values in the control group(p < 0.05). The normal hearing rate of patients with sickle cell anemia has been determined to be 71.1% conductive hearing loss (CHL) to be 4.4%, sensorineural hearing loss (SNHL) to be 22.2%, and mixed type hearing loss to be 2.2% in right ear; the normal hearing rate has been determined to be 71.1%, CHL to be 2.2%, SNHL to be 22.2%, and mixed type hearing loss to be 4.4% in left ear. Statistically significant difference has not been found between head shake, spontaneous nystagmus, optokinetic, tracking test batteries, static and dynamic positional tests used in VNG, saccade accuracy and saccade peak velocity, which are saccadic test findings of 2 groups. However, saccadic latency, which is a saccadic test finding, has been determined to be longer in patients with sickle cell anemia in comparison to the control group. CONCLUSION: While sickle cell anemia causes hearing deficits, it does not have any effect on the central or peripheral vestibular system.

Antronasal Polyp Extending to Orbital Fossa.

Sinonasal infections and nasal polyps can be taken as 2 components of a disease. Polyps due to chronic inflammations of nasal cavity and sinuses are not rare. They may present with various clinical signs and symptoms, while the secondary complications may cause serious problems. They are most commonly treated medically, although surgery is the therapy of choice in some conditions. The complications can be listed as mucocele formation, orbital inflammation, intracranial extension by erosion of the boney structures.

The effect of caffeic acid phenethyl ester and thymoquinone on otitis media with effusion in rats.

OBJECTIVE: In this study, we aimed to investigate the effect of CAPE and thymoquinone in experimental rat otitis media with effusion (OME) model. METHODS: Intraoral approach of eustachian tube orifice cauterization were administered to 36 of 40 rats participating the study. After application of exclusion criterias, 22 rats with appropriate conditions were determined. Totally 26 rats (44 otitis model ears and 8 normal ears) were randomly divided into 5 groups. While group I was consisted of healthy rats, the other groups were consisted of rats with otitis model. Group I (saline + control group; n = 8 normal ears) and group II (saline + otitis model; n = 10 otitis model ears) received intraperitoneally saline solution. CAPE was given intraperitoneally to group III (CAPE + otitis model; n = 12 otitis model ears) at a concentration of 10 mg/kg for treatment of otitis media. Group IV (thymoquinone + otitis model; n = 12 otitis model ears) was treated orally with 10 mg/kg of thymoquinone. Group V (methylprednisolone + otitis model; n = 10 otitis model ears) was treated intraperitoneally with 1 mg/kg of methylprednisolone. Tympanic bulla samples were excised after 10th day of treatment and examined under light microscopy. RESULTS: Submucosal neutrophil leukocyte count of group I was significantly lower than other groups (II, IV, V) (respectively p < 0,0001, p < 0,001, p < 0,0001, Tukey test), while it was not significantly different from group III (p = 0,056, Tukey test). Submucosal neutrophil leukocyte count of group III was significantly lower than group II and group V (p = 0.029 ve p = 0.03, Tukey test). There was no significant difference between group IV and group V (p = 0,28, Tukey test). CONCLUSION: Based on these findings, it could be suggested that CAPE, anti inflammatory properties proven in the literature, plays an important role in OME treatment.

Aberrant Internal Carotid Artery in the Tympanic Cavity.

OBJECTIVES: Presence of aberrant internal carotid artery (ICA) in the tympanic cavity is a very rare case and therefore the diagnosis is a challenge. Here, the authors aimed to address the importance of the diagnosis since the intervention to the middle ear and implants is increasing in number and this condition may lead to life-threatening bleeding. METHODS: Between 2012 and 2016, among the patients referred to the authors' Radiology Department from the Department of Otolaringology for the evaluation of the temporal region for various indications, the authors reported this anomaly in 6 patients and multidetector computerized tomography of these 6 patients and magnetic resonance imaging of 2 were assessed in detail. RESULTS: The mean age of the 6 patients was 28.8 and aberrant ICA abnormality was observed in 2 patients bilaterally and 4 patients unilaterally on the right side. In 1 patient ICA was not totally regressed and observed as hypoplastic. In one of the patients, dehiscence was evident between ICA and the cochlea. Moreover, in 1 patient the contralateral ICA was not observed. CONCLUSION: Although rare, aberrant ICA is an abnormality that should be kept in mind by the clinicians and the radiologists, since it leads to abundant bleeding when undiagnosed before the surgical interventions.

Endoscopic dacryocystorhinostomy with silicone, polypropylene, and T-tube stents; randomized controlled trial of efficacy and safety.

OBJECTIVE: To compare the efficacy and safety of endoscopic dacryocystorhinostomy (En-DCR) with different stent materials for lacrimal sac intubation in primary nasolacrimal ductal obstructions. STUDY DESIGN: Randomized controlled study with three parallel groups. Level of evidence is 1b. METHODS: A total of 91 patients (five bilateral) with primary nasolacrimal duct obstruction (NLDO) at a tertiary referral center scheduled for En-DCR were to allocated into three stent groups with a sealed envelope and were randomized into three treatments: silicone, Prolene (polypropylene), and otologic T-tube. Ophthalmology and otolaryngology clinics evaluated the patients preoperatively and postoperatively with endoscopes, lacrimal system syringing, and dacryocystography. The success of the stents was evaluated 12 months after surgery with symptom relief and ostial patency. Complications were also noted. RESULTS: The overall success rate of the En-DCR in the stent groups was 78.1% (75/96); specifically, 87.5% (28/32) with silicone, 84.4% (27/32) with Prolene, and 62.5% (20/32) with T-tube. The efficacy of the procedures with the T-tube was significantly lower than that of the Prolene and silicone (p = .031, χ(2) test). There were no significant differences between the silicone and Prolene (p = .718, χ(2) test). Prolene was found to be related with orbital complications. Spontaneous loss is a particular complication of otologic T-tube and highly portends to failure. CONCLUSIONS: The results of our study suggest that efficacy, defined as anatomic and functional success, is equally high for silicone and Prolene stents and lower for otologic T-tube in En-DCR.

The Efficacy of Sucralfate and Chlorhexidine as an Oral Rinse in Patients with Recurrent Aphthous Stomatitis.

Aim. In this study, we compared the efficacy of sucralfate suspension with chlorhexidine as an oral rinse in patients with recurrent aphthous stomatitis (RAS) in terms of pain relief and healing time. Materials and Methods. The subjects with a complaint of recurrent oral aphthous ulcers less than 1 cm in diameter on the first day of the occurrence of the ulcer and between 20 and 40 years were included in the study. Seventy patients completed the study. The patients were randomized into two groups as SCH group and CHX group. Changes in pain scores, healing time, and side effects of the treatments were evaluated. Results. The mean value of pain scores on the days after the treatment from the first day to the seventh day was significantly higher in CHX group than SCH group (P ≤ 0.05). On the seventh day after the treatment, the ulcers were completely reepithelialized in 23 patients in SCH group and in 19 patients in CHX group. The difference was statistically significant (P ≤ 0.05). In SCH group, the mean healing time of ulcers was 1.97 ± 1.56 days whereas it was 2.80 ± 3.00 days in CHX group. The difference was statistically significant (P ≤ 0.05). No side effects were recorded in either of the groups. Conclusion. Topical sucralfate suspension is an easy, safe, inexpensive, and effective treatment option for RAS to obtain pain relief and shorten the healing time of oral ulcers.

The Score For Allergic Rhinitis study in Turkey.

BACKGROUND: The clinical definition of allergic rhinitis (AR) is difficult to use in epidemiological settings of large populations where it is impossible to obtain the laboratory evidence of each immune response. However, the standardization of the definition of AR in epidemiological studies is of crucial importance. This study was designed to estimate the prevalence of AR in an adult general population with respect to seven distinct geographical regions in Turkey. METHODS: Individuals were evaluated with the Score for Allergic Rhinitis (SFAR) questionnaire for a national cross-sectional study. The Turkish version of the SFAR questionnaire was tested for clarity and sensitivity in a small sample of the general population. RESULTS: Among the 3967 interviewed subjects, the overall prevalence of AR was 29.6%, with regional variations (from 21.0% in the southeastern Anatolia region to 36.1% in the Marmara region). The prevalence was higher in women and in urban area of residence. CONCLUSION: This national survey confirmed the elevated prevalence of AR in Turkey. Our findings may contribute to the formulation of the public health policy and development of preventive and therapeutic strategies for AR in eastern Europe.

Intravenous ketamine and local bupivacaine infiltration are effective as part of a multimodal regime for reducing post-tonsillectomy pain.

BACKGROUND: The aim of this study was to investigate the effects of a multimodal analgesic regimen, including intravenous ketamine and peritonsillar infiltration of bupivacaine, on post-tonsillectomy pain in children. MATERIAL/METHODS: Ninety children aged 2-12 years, undergoing tonsillectomy, were enrolled in this randomized, controlled and double-blinded study. Group I (n=30) received intravenous and peritonsillar saline, group II (n=30) received intravenous saline and peritonsillar bupivacaine, and group III (n=30) received intravenous 0.5 mg/kg ketamine and peritonsillar 0.25% bupivacaine (3-5 ml per tonsil). Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24 h postoperatively. RESULTS: No difference was found in the demographic data among the groups. Group I patients who received intravenous and peritonsillar saline solution as placebo had higher pain scores at 15th min, and 1st and 4th h than group II, and at all time intervals, than group III (P<0.05). Patients in group III also had significantly lower pain scores than group II at all time intervals except at 15th min (P<0.05). Analgesic requirements and the time to first analgesia were also significantly (P<0.05) better in the ketamine group. CONCLUSIONS: Intravenous ketamine and peritonsillar infiltration with bupivacaine are safe and effective as part of a multimodal regime in reducing post-tonsillectomy pain.

Ex vivo tracheal mucociliary clearance in rats: comparisons of nebulization versus irrigation with lactated Ringer and saline solutions.

OBJECTIVE: This study was performed to compare the effects of isotonic saline, hypertonic saline (buffered/nonbuffered), and lactated Ringer irrigation and distilled water nebulization on mucociliary clearance in ex vivo rats. DESIGN: Experimental study. SETTING: Tertiary otolaryngology care centre. METHODS: Thirty rat tracheas were achieved from 15 rats by dividing the trachea longitudinally into two equal parts. MAIN OUTCOME MEASURES: Mucociliary transport velocity was measured by direct observation of particle placed on the lower end of the trachea after irrigation or nebulization. RESULTS: Significant improvement in mucociliary clearance was found with isotonic saline (p = .002), buffered hypertonic saline (p = .018), lactated Ringer (p = .000), and nebulized distilled water (p = .000) when compared with nonbuffered hypertonic saline. CONCLUSION: Lactated Ringer solution is better than saline solution at enhancing mucociliary clearance, but nebulized distilled water is superior to the tested irrigation solutions in rat tracheal epithelium.

The effect of dacryocystorhinostomy on mucociliary function.

OBJECTIVE: External dacryocystorhinostomy is suspected to cause mucociliary dysfunction by affecting ciliary activity and quality of the mucus. We hypothesized that patients who undergo endoscopic dacryocystorhinostomy may also experience mucociliary dysfunction. We evaluated the effects of surgery on mucociliary clearance time in patients who underwent endoscopic dacryocstorhinostomy and external dacryocstorhinostomy. STUDY DESIGN: A prospective controlled study. SUBJECTS AND METHODS: Forty-four patients were studied: 22 had undergone one-sided endoscopic surgery and 22 had undergone one-sided external surgery for nasolacrimal duct obstruction. Nonoperated sides of the both groups were remained as controls. The saccharin test was used to evaluate the mucociliary clearance time of the both sides. RESULTS: Dacryocystorhinostomy, results in prolonged mucociliary clearance times either endoscopic or external approach is performed (P < 0.001, paired t test). There was no significant difference between the mucociliary clearance times after endoscopic and external dacryocystorhinostomy (P = 0.22, Student's t test). CONCLUSION: Dacryocystorhinostomy impairs mucociliary function independent of the type of surgery.

Prolene: a novel, cheap, and effective material in dacryocystorhinostomy.

CONCLUSION: Prolene is cheap, effective, and readily available in almost all operating theaters. It might be used successfully in endoscopic dacryocystorhinostomy and is promising as an alternative to silicone stent intubations, especially in settings with limited resources. OBJECTIVE: To evaluate the clinical efficacy and results of stenting with polypropylene (Prolene; Ethicon, Inc.) suture material instead of silicone tube in endoscopic dacryocystorhinostomy. PATIENTS AND METHODS: Forty-two endoscopic dacryocystorhinostomy operations were performed in 36 patients (11 men and 25 women; mean age 34.7 + or - 9.5 years, range 16-60 years) between 2007 and 2008. After creating an aperture in the medial wall of the lacrimal sac, 2/0 Prolene was inserted through the canaliculi into the sac. The Prolene was left in the lacrimal sac for 3 months. The patients were followed up for between 6 and 18 months (mean 8.1 + or - 3.6 months). The improvement in the complaint of epiphora was grouped as very good, good, or no change. RESULTS: The improvement in 34 eyes (81%) was reported as very good, whereas improvement was noted as good in 5 eyes (11.9%), and there was no change in 3 eyes (7.1%). We observed granulation tissue formation around the Prolene in two patients.

The prevalence and significance of incidental middle ear and mastoid cavity abnormalities on MRI in a pediatric population.

OBJECTIVE: The purposes of this study were to determine the prevalence of abnormalities in the middle ear and mastoid cavity on the magnetic resonance imaging (MRI) in children and correlate the results with clinical data, tympanometric findings and paranasal sinus changes. MATERIALS AND METHODS: A total of 85 consecutive pediatric patients for suspected non-inflammatory intracranial pathologies were prospectively examined. MRI was conducted for the suspected intracranial pathology. All patients were also examined by an otolaryngologist for otologic pathologies. A tympanometry examination was performed in patients prior to MRI scan. RESULTS: In 23 (27.1%) of 85 (39 males, 46 females) children, MRI demonstrated middle ear and/or mastoid cavity abnormalities. MRI abnormalities of the middle ear and/or mastoid cavity were correlated with clinical data and tympanometric findings. CONCLUSIONS: Incidental abnormal signal intensities in the middle ear and/or mastoid cavity are frequent in children, especially in first years of life. MRI will demonstrate incidental middle ear and mastoid cavity abnormalities seems to have clinical significance.

Retropharyngeal hematoma as a complication of anticoagulation therapy.

Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach--intubation, tracheotomy, or conservative therapy--is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.

The effect of anesthetic agents on perioperative bleeding during tonsillectomy: propofol-based versus desflurane-based anesthesia.

OBJECTIVE: Hemorrhage during tonsillectomy is related to the surgical technique, management of bleeding, and choice of anesthetic agent. This study evaluated the effects of anesthetic agents on hemorrhage during tonsillectomy with standardized surgical techniques and management of bleeding. STUDY DESIGN: Double-blind, randomized controlled trial. SUBJECTS AND METHODS: Sixty patients, aged 3 to 12 years, who were scheduled for elective tonsillectomy were enrolled in the study. Propofol-based anesthesia was administered to the first group; desflurane-based anesthesia, to the second. The amount of blood loss due to hemorrhage was measured. RESULTS: Propofol-based anesthesia significantly decreased bleeding during tonsillectomy. CONCLUSION: Propofol-based anesthesia is a reliable method for use in children who undergo tonsillectomy.

Acute 'upside-down' visual inversion due to multiple sclerosis.

In a 20-year-old male patient, a 180 degree inversion of visual image was found as a manifestation of multiple sclerosis. Upside down reversal of vision is not a well-known sign in multiple sclerosis. Exact mechanism is still unknown. Lesions involving cortical areas, mainly the parieto-occipital region, have occasionally been documented. To our knowledge this is the first report of upside-down reversal of vision in multiple sclerosis with cerebra lesion on MRI.

Concha bullosa pyocele.

An aerated middle turbinate is called a concha bullosa (CB), and given the importance of the middle turbinate in nasal physiology, variations that alter the airflow and mucous drainage can cause sinonasal symptoms. A pyocele of the middle turbinate differs from an infected CB because it has the potential to expand and destroy neighbouring tissues like a tumour. We present a concha bullosa pyocele (CBP) that expanded against the lamina papyracea without causing orbital displacement. As pus was discharged whilst performing an endoscopic biopsy to determine whether it was neoplastic, the lateral aspect of the turbinate was excised to complete the procedure.