Hearing loss in Takayasu's arteritis.

OBJECTIVES: Neurosensory hearing loss is well-documented in chronic autoimmune conditions such as systemic lupus erythematosus (SLE). However, the literature lacks data on the prevalence and characteristics of hearing impairment in Takayasu's arteritis (TAK). In this cross-sectional study, our principal objective was to systematically assess the auditory function of individuals diagnosed with TAK, against SLE patients and healthy controls (HC). METHODS: Age and gender matched TAK and SLE patients followed up in a tertiary centre along with healthy controls were included in a two-phase study. In the first phase, a questionnaire on ENT symptoms was administered to the patient (TAK: n=104 and SLE: n= 151) and HC (n=174) groups. In the second phase, patients (TAK: n=53 and SLE: n=33) and HC (n=45) underwent audiometric tests. RESULTS: The questionnaire survey revealed that both TAK and SLE patients reported hearing loss (27.9%, 25.8%, 7.4%, p<0.001), tinnitus (49%, 35.8%, 13.8%, p<0.001) and vertigo (46.2%, 33.8%, 16.7%, p<0.001) at significantly higher rates than HC. Audiometry results indicated that both TAK (30.2%) and SLE patients (18.2%) had increased hearing loss compared to HC (8.9%), however, only TAK patients were found to have significantly increased risk in age adjusted logistic regression analysis (OR= 3.915, 95%CI: 1.179-12.998, p=0.026). Hearing loss was mainly neurosensory in all groups. TAK patients were affected at both low (<6000 Hz) and high (>6000 Hz) frequencies, whereas SLE patients were affected only at high frequencies. Hearing loss was significantly associated only with older age. No association was observed with the anatomical location of vascular involvement or history of stroke. CONCLUSIONS: Our study reveals an increased prevalence of hearing loss in TAK. Further research is crucial to uncover the underlying causes.

The uselessness of using salivary microbiota in forensic identification purposes of a person with recent antibiotic use.

The detection of microbial flora changes in saliva samples because of antibiotic use through advanced molecular genetic analysis is important for forensic and clinical applications. This study aims to reveal the variability in the microbial structure of human saliva after antibiotic use with metagenomic analysis techniques from a forensic point of view. Within the scope of the study, saliva samples were collected from patients who were under the effect of regional anesthesia to be administered a standardized course of antibiotic therapy that lasted for a week. The analysis was conducted on 56 saliva samples from 14 individuals over four different time intervals. Isolation of the 16S rRNA region and PCR analysis were performed prior to sequence analysis to determine the microbiome structure of the samples at phylum, genus, and species levels. As expected, changes were observed in bacterial species found in saliva samples after administration of antibiotics and this was linked to the specific type of antibiotics that were administered. This change was statistically significant for Firmicutes, Spirochetes, and Verrucomicrobiota. Furthermore, although the oral microbiome tends to return to its former state at the phylum and genus level within a 4-week period after the start of antibiotic use, it is observed that the change, especially in some bacterial species, still continues. The findings of this study show that because of the inability of stabilization at species-level in a period of 4 weeks from the start of antibiotic use, it is not suitable to assess saliva samples at species-level for forensic identification.

Investigation of Toll-like Receptor-2, -3 and -4 Gene Expressions in Larynx Squamous Cell Carcinoma.

Objective: Despite all the recent advancements, larynx cancer has shown no improvement in survival rates. The aim of this study was to investigate the expressions of toll-like receptor (TLR)-2, -3, and -4 genes, and determine any relationships with the histopathologic characteristics of the disease. Methods: This retrospective study included 50 subjects who underwent total or partial laryngectomy with an open surgical method for larynx squamous cell carcinoma. Measurements of TLRs-2, -3, and -4 expression values were taken with quantitative real time-polymerase chain reaction in normal tissue and tumor tissue samples of the patients. Results: Evaluations were made of TLR-2, -3, and -4 mRNA expressions according to 2-ΔΔCT calculations in 50 subjects with larynx cancer. When the tumor tissue was compared with the healthy tissue from the same subjects, reductions were determined in TLR expression in 86%, 84%, and 82%, respectively. This reduction in each gene expression was statistically significant (p<0.001). No statistically significant correlation was determined between the change in TLR-2, -3, and -4 expression and the histopathologic characteristics of the disease. Conclusion: The data obtained in this study demonstrated that TLR-2, -3, and -4 expressions were reduced in larynx squamous cell cancer. The results of further studies targeting these genes would be useful in the diagnosis and treatment of the disease.

The Role of Preemptive Infiltration Anesthesia in the Management of Postoperative Pain Following Septoplasty

Abstract Introduction Septoplasty is one of the most common surgical procedures in rhinology practice. Two major problems encountered after septoplasty are pain and bleeding. Preoperative administration of analgesics before the surgical stimulus, which is the main concept of preemptive analgesia, decreases postoperative pain. Objective The present study was designed to investigate whether preincisional lidocaine infiltration to the subperichondrial area during septoplasty surgery reduced or not postoperative pain and analgesic use. Methods The present prospective, randomized, placebo controlled, double-blind trial was conducted on 64 consecutive patients with nasal septum deviation. Patients were randomly divided into 2 groups; the study group received 2% 20 mg lidocaine/cc (n = 31), and the control group received 6 cc 0.9% NaCl (n = 33). A standard questionnaire was given to each patient to mark his or her pain score between 0 and 10 at the 1st, 3rd, 6th, 12th, and 24th hours. Results The mean and the range of visual analogue scale (VAS) scores of the patients in the study group at the 1st, 3rd, 12th, and 24th hours were 4.03 ± 3.08 (0-10); 3.42 ± 2.39 (0-8); 2.97 ± 2.22 (0-8); 2.87 ± 2.61 (0-9); and 1.94 ± 2.06 (0-9) respectively. The mean and the range of VAS scores of the patients in the control group at the 1st, 3rd, 12th, and 24th hours were 4.12 ± 2.7 (0-10); 3.45 ± 2.4 (0-10); 2.94 ± 2.7 (0-10); 2.79 ± 2.34 (0-10); and 1.5 ± 1.8 (0-6), respectively. The statistical analysis revealed no significant difference among the groups. Conclusion The preemptive local anesthetic administration to the incision area and under the mucoperichondrial flap before septoplasty does not decrease the level of postoperative pain.

The Role of Preemptive Infiltration Anesthesia in the Management of Postoperative Pain Following Septoplasty.

Introduction Septoplasty is one of the most common surgical procedures in rhinology practice. Two major problems encountered after septoplasty are pain and bleeding. Preoperative administration of analgesics before the surgical stimulus, which is the main concept of preemptive analgesia, decreases postoperative pain. Objective The present study was designed to investigate whether preincisional lidocaine infiltration to the subperichondrial area during septoplasty surgery reduced or not postoperative pain and analgesic use. Methods The present prospective, randomized, placebo controlled, double-blind trial was conducted on 64 consecutive patients with nasal septum deviation. Patients were randomly divided into 2 groups; the study group received 2% 20 mg lidocaine/cc ( n = 31), and the control group received 6 cc 0.9% NaCl ( n = 33). A standard questionnaire was given to each patient to mark his or her pain score between 0 and 10 at the 1 st , 3 rd , 6 th , 12 th , and 24 th hours. Results The mean and the range of visual analogue scale (VAS) scores of the patients in the study group at the 1 st , 3 rd , 12 th , and 24 th hours were 4.03 ± 3.08 (0-10); 3.42 ± 2.39 (0-8); 2.97 ± 2.22 (0-8); 2.87 ± 2.61 (0-9); and 1.94 ± 2.06 (0-9) respectively. The mean and the range of VAS scores of the patients in the control group at the 1 st , 3 rd , 12 th , and 24 th hours were 4.12 ± 2.7 (0-10); 3.45 ± 2.4 (0-10); 2.94 ± 2.7 (0-10); 2.79 ± 2.34 (0-10); and 1.5 ± 1.8 (0-6), respectively. The statistical analysis revealed no significant difference among the groups. Conclusion The preemptive local anesthetic administration to the incision area and under the mucoperichondrial flap before septoplasty does not decrease the level of postoperative pain.

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves? / O tamanho do nervo coclear afeta o desempenho auditivo pós-operatório em pacientes pediátricos com implante coclear e nervos cocleares normais?

Abstract Introduction Cochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance. Objective To investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance. Methods 30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance. Results The mean diameter of the cochlear nerve on the ipsilateral side was 718.4 μm (504.5 − 904.3 μm) and mean cross sectional area was 0.015 cm2 (0.012 − 0.018 cm2). On the contralateral side the mean cochlear nerve diameter was 714.4 μm (502.6 − 951.4 μm) and mean cross sectional area was 0.014 cm2 (0.011 − 0.019 cm2). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 − 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 − 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 − 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 − 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve. Conclusion Measuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.

Resumo Introdução O implante coclear é um método de tratamento eficaz para a perda auditiva grave a profunda. Muitos fatores que podem influenciar o sucesso do implante coclear foram explicados em estudos anteriores. Além desses fatores, pequenas diferenças no tamanho dos nervos cocleares normais podem afetar o desempenho pós-operatório. Objetivo Investigar se pequenas diferenças no tamanho dos nervos cocleares normais afetam o desempenho pós-operatório do implante coclear. Método Foram incluídos neste estudo 30 pacientes pediátricos surdos pré-linguais, tratados com implante coclear. A partir de imagens de ressonância magnética parassagitais reconstruídas, foram medidos o diâmetro e a área de seção transversal do nervo coclear no lado ipsilateral e contralateral. As avaliações auditivas foram feitas 1, 3, 6 e 12 meses após a primeira adaptação. Todas as análises foram feitas com a ferramenta EARS® (do inglês evaluation of auditory responses to speech). A correlação entre o diâmetro do nervo coclear, a área transversal e a percepção auditiva pós-operatória foi analisada para determinar se a variação no tamanho do nervo coclear contribui para o desempenho auditivo pós-operatório. Resultados O diâmetro médio do nervo coclear no lado ipsilateral foi de 718,4 μm (504,5 a 904,3 μm) e a área da seção transversal média foi de 0,015 cm2 (0,012-0,018 cm2). No lado contralateral, o diâmetro médio do nervo coclear foi de 714,4 μm (502,6 a 951,4 μm) e a área da seção transversal média foi de 0,014 cm2 (0,011 a 0,019 cm2). A correlação entre o diâmetro e a área transversal do nervo coclear ipsilateral e contralateral não revelou qualquer significância. O escore médio do teste monosyllable-trochee-polysyllable no primeiro mês, denominado MTP1, foi de 0,17 (0,08-0,33), no sexto mês com teste de 6 palavras, MTP6, foi de 0,72 (0,39-1,0), no sexto mês com 12 palavras, MTP12, foi de 0,46 (0,17-0,75) e no 12° mês com 12 palavras, MTP12, foi de 0,73 (0,25-1,0). Não houve correlação entre os valores do teste monosyllable-trochee-polysyllable em qualquer momento com o diâmetro do nervo coclear ipsilateral. Entretanto, o teste monosyllable-trochee-polysyllable do primeiro mês, do 6° mês, e o do 12° mês correlacionaram-se com a área transversal do nervo coclear ipsilateral. Conclusão Medir a área da secção transversal do nervo coclear de aparência normal pode fornecer conhecimento prognóstico importante sobre os resultados do implante coclear. Em pacientes com área da secção transversal maior, o desempenho auditivo foi melhor e mais rápido. Embora o nervo coclear pareça normal, pequenas diferenças na área da secção transversal do nervo coclear podem afetar o desempenho, de forma que a medida do tamanho do nervo coclear nas imagens de ressonância magnética na projeção parassagital pode fornecer informações benéficas sobre o processo de reabilitação pós-operatória.

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves?

INTRODUCTION: Cochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance. OBJECTIVE: To investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance. METHODS: 30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance. RESULTS: The mean diameter of the cochlear nerve on the ipsilateral side was 718.4 µm (504.5 - 904.3 µm) and mean cross sectional area was 0.015 cm2 (0.012 - 0.018 cm2). On the contralateral side the mean cochlear nerve diameter was 714.4 µm (502.6 - 951.4 µm) and mean cross sectional area was 0.014 cm2 (0.011 - 0.019 cm2). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 - 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 - 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 - 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 - 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve. CONCLUSION: Measuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.

Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center.

PURPOSE: This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not. METHODS: Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted. RESULTS: A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class (r = .39; P = .04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors (r = .34; P = .089 and r = .34; P = .087, respectively). Age was significantly and negatively correlated to vascular injury (r = -.51; P = .05). Vascular injury was significantly correlated with gender (male predominance: r = -.64; P = .000). CONCLUSION: Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization.

Programmed Death Ligand 1 Expression in Laryngeal Squamous Cell Carcinomas and Prognosis.

AIM: We aimed to show the immunohistochemical expression of programmed death ligand 1 (PD-L1) in laryngeal squamous cell carcinomas (SCCs). MATERIALS AND METHODS: The study includes 52 laryngeal SCC cases that underwent surgical resection. Immunohistochemical staining of PD-L1 (Clone 22C3) was applied to the sections obtained from paraffin blocks. Combined Positive Score (CPS) was evaluated as described in manuals. Tumor Proportion Score (TPS) was assessed by the percentage of positive tumor cells which were designated as positive if ⩾1% of the tumor cells showed membranous staining. RESULTS: There were 35 cases (67.3%) having CPS < 1 and 17 cases (32.7%) having CPS ⩾ 1. There was no relationship between CPS, TPS, and the clinicopathological data. CONCLUSION: Further studies with a large number of advanced-stage cases are needed.

The Efficacy of Intratympanic Steroid Injection in Tinnitus Cases Unresponsive to Medical Treatment.

OBJECTIVES: To examine the efficacy of an intratympanic steroid injection in tinnitus cases unresponsive to medical treatment. MATERIALS AND METHODS: The study was carried out at the Ear, Nose, and Throat Department with 107 patients (46 male, 61 female) between the ages of 20 and 77 with a mean of 42.8 years who had idiopathic tinnitus. Patients were randomized by simple randomization to receive intratympanic dexamethasone or isotonic solution. The patients received six intratympanic injections, two per week for three weeks. Tinnitus handicap index (THI) was performed before treatment and at first week, first month, and six months after the completion of the study protocol. The audiometric tests were performed six months after the treatment. RESULT: In the study group, pretreatment THI and post-treatment first month THI scores and pretreatment THI and post-treatment sixth month THI scores were significantly different whereas the same scores were not significantly different in the control group. The comparison of THI scores between the groups revealed significantly lower scores in the first and sixth months for the study group. CONCLUSION: The effect of the intratympanic injection of dexamethasone on the efficacy of treatment of tinnitus severity was statistically significant.

Extra-Cochlear Insertion in Cochlear Implantation: A Potentially Disastrous Condition.

OBJECTIVES: Cochlear implantation is an increasingly used technique for auditory rehabilitation of pediatric and adult population. Safe implantation is achieved in most cases; however, intraoperative complications and misplacement of the electrode are observed in some. The aim of this presentation was to review the characteristics of patients with extra-cochlear electrode insertion, postoperative diagnostic methods, and considerations in revision surgery. MATERIALS AND METHODS: In total, 423 cases of cochlear implantation performed in our clinic between 2012 and 2018 were retrospectively analyzed and those of extra-cochlear implantation were evaluated. RESULTS: Extra-cochlear insertion was found in 3 patients. The electrode was placed into the internal acoustic canal in the first case, superior semicircular canal in the second case, and internal carotid artery canal in the third case. Cochlear insertion was achieved in all cases with re-implantation, and no complication was observed. CONCLUSION: This case series highlights that rare, but potentially serious, consequences of misplacement of the electrode in cochlear implantation can be successfully avoided and treated via a multidisciplinary approach.

Closure of Orocutaneous Fistula Using Submandibular Gland as a Pedicled Flap.

Orocutaneous fistulas in the maxillofacial region may be due to tumor resection, osteoradionecrosis, or trauma, and these defects limit the function of the patients and effect aesthetic and also psychological condition. Articulation and nutrition are also affected by these fistulas. Local flaps can be used for the reconstruction of small- and medium-sized defects with ease. Submandibular gland with its rich blood supply from the facial artery is a practical and useful choice for the reconstruction of mandibular region defects.

Osteosarcoma of the Ethmoid Sinus.

Osteosarcoma (OS) is a malignant bone tumor and it is very rare in head and neck region. If it arises in this area, most common localizations of this tumor are mandible and maxilla and ethmoid sinus is very rare site for this malignancy. A 43-year-old female admitted to our clinic with the complaint of pain in the right half of the face and headache persisting for 2 months. According to the clinical symptoms and imaging studies, sinonasal ossifying fibroma was suspected. For this reason, patient was operated endoscopically and histopathological examination revealed that osteoid matrix producing atypical osteoblastic cells so these findings identified osteoblastic variant OS. This article is about a very rare case of OS of ethmoid sinus. The differential diagnosis, general characteristics, and classification of this tumor, radiological features, and surgical techniques are also presented.

A Rare Cause of Objective Tinnitus: Jugular Diverticulum.

The jugular bulb is a venous structure linking the sigmoid sinus with the internal jugular vein. Jugular diverticulum is a rare condition characterized by extraluminal outpouching from the jugular bulb. As the patients may be totally asymptomatic, but sensorineural symptoms such as sensorineural hearing loss, tinnitus and vertigo can also occur. Diagnosis of these patients can be made by some radiologic methods such as high-resolution computerized tomography, magnetic resonance imaging, or a novel radiologic technique flat panel computed tomography. In this paper we report a 22-year-old female patient with jugular diverticulum presenting with tinnitus complaint.

Cervical Necrotizing Fasciitis of Odontogenic Origin and Hyperbaric Oxygen Therapy.

Necrotizing fasciitis (NF) is an infection of the soft tissues pathology with high mortality that spreads through the fascial planes and rarely seen in head and neck region. The cause of infection is often odontogenic problems. Broad-spectrum antibiotics, surgical debridement, and hyperbaric oxygen therapy (HBO) are important for the treatment of disease. We report a case of cervical NF in a 33-year-old woman who was treated with rapid surgical debridement and simultaneous HBO.

Cellular Angiofibroma of the Nasopharynx.

Angiofibroma is a common tumor of the nasopharynx region but cellular type is extremely rare in head and neck. A 13-year-old boy presented with frequent epistaxis and nasal obstruction persisting for 6 months. According to the clinical symptoms and imaging studies juvenile angiofibroma was suspected. Following angiographic embolization total excision of the lesion by midfacial degloving approach was performed. Histological examination revealed that the tumor consisted of staghorn blood vessels and irregular fibrous stroma. Stellate fibroblasts with small pyknotic to large vesicular nuclei were seen in a highly cellular stroma. These findings identified cellular angiofibroma mimicking juvenile angiofibroma. This article is about a very rare patient of cellular angiofibroma of nasopharynx.