Evaluation of the vestibular system in individuals with presbycusis using video head impulse test and videonystagmography.

BACKGROUND: Vestibulo-ocular reflex (VOR) function is expected to be normal in patients with presbycusis during sudden head rotations. AIM: This study aimed to determine whether presbycusis was accompanied by vestibular system pathologies. In addition, it was examined whether there was a difference existed between the patients with and without presbycusis in terms of normative data. MATERIALS AND METHODS: A total of 40 individuals were included in the study: 20 in the presbycusis group and 20 in the control group. The vestibular systems of both groups were evaluated using the video head impulse test and videonystagmography. RESULTS: The right and left lateral VOR gain values were decreased in the group with presbycusis compared to the control group. The difference between the two groups in the mean VOR gains in the right lateral canal and left lateral canal were statistically significant (p = .040 and p = .050, respectively). The air caloric tests of all individuals were found to be normal. CONCLUSIONS: This result suggests that the loss of vestibular hair cells and vestibular nerve degeneration in the lateral semicircular canal may be more severe in presbycusis than in the same age group with normal hearing.

Our experience on the management of acute mastoiditis in pediatric acute otitis media patients.

OBJECTIVE: The incidence of complications due to acute otitis media (AOM) in childhood has decreased significantly with the use of new antibiotics in recent years. However, acute mastoiditis (AM) is still the most common complication that can lead to further intracranial conditions with high morbidity. Our study aimed to evaluate the clinical characteristics of children with AM and identify possible indicators for further intracranial complications associated with this condition. METHODS: Children hospitalized in our clinic with a diagnosis of AM were reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatments modalities, and culture results were screened. The patients were divided into two groups as those with and without intracranial complications (ICCs). Routine complete blood count tests, biochemical analysis, and C-reactive protein (CRP) level measurement were evaluated and compared between the groups. RESULTS: Of the 28 AM patients, five (17.9%) had isolated AM. Complications associated with AM included sub-periosteal abscess (28.6%), facial paralysis (25%), meningitis (17.9%), meningitis with sigmoid sinus thrombosis (7.1%), and meningitis with cerebellar abscess (3.6%). Eight patients developed ICCs (28.6%), of whom three had more than one complication. Ceftriaxone was found to be the first-line medical treatment (57.1%). Streptococcus pneumoniae was the most common pathogen isolated from the cultures (42.9%). Three patients (10.7%) were treated non-surgically, eight (28.6%) with myringotomy and ventilation tube (VT) insertion, eight patients (28.6%) with abscess drainage and VT insertion, and nine (32.1%) with cortical mastoidectomy and VT insertion. There was no significant difference between the patients with and without ICCs in terms of complete blood count parameters. The CRP level and the CRP-albumin ratio were significantly higher in patients with ICCs than those without these complications (p < 0.001). CONCLUSION: AM remains to be the most common complication of AOM in childhood and can lead to further life-threatening conditions. Additional interventions according to the type of the complication with VT insertion is safe and effective in the management of AM. In patients with AM, it is of great importance to determine whether there is an accompanying ICC. The CRP-albumin ratio is a simple and reliable calculation to detect ICCs in patients with AM.

GPER-1 and sex-hormone levels in patients with otosclerosis.

OBJECTIVE: Otosclerosis is a widespread disease but the etiopathogenesis is still not fully understood. Hormonal factors especially estrogens are accused in recent years. The study aimed to evaluate the levels of G-protein associated membrane estrogen receptor-1 (GPER-1) and sex-hormones in patients with otosclerosis. SUBJECT AND METHODS: The study included 60 people (30 otosclerosis patients, 30 control group). Serum sex-hormone (estradiol, progesterone, prolactin and total testosterone) and GPER-1 levels were measured in otosclerosis patients and compared with the normal population. For the otosclerosis group, air conduction and bone conduction thresholds and air-bone gaps were viewed from audiograms and the relationships between hearing and GPER-1 or sex-hormone levels were also investigated. RESULTS: Sex-hormone levels were not different between the groups. GPER-1 level was significantly lower in the otosclerosis group [3.1353 (0.76-8.21) ng/mL] than the control group [5.4773 (0.96-20.31) ng/mL] (p =0.017). Differential diagnosis with ROC analysis for the GPER-1 level was also significant (p=0.017). GPER-1 level was significantly lower for the females than the males in the otosclerosis group (p=0.043). Serum estradiol, progesterone, and prolactin levels were significantly higher (p=0.02, p =0.029 and p=0.019 respectively) and the GPER-1 level was significantly lower (p= 0.04) in the female patients compared to the female controls. There was no statistically significant relationship between GPER-1 or sex-hormone levels and hearing parameters. CONCLUSION: GPER-1 level was lower in the otosclerosis patients compared to healthy volunteers and also lower in females than males in the patient group. Female sex-hormone levels were higher and GPER-1 level was lower in the female patient group than the female control group. Neither GPER-1 nor sex-hormone levels were not predictive of hearing levels. These findings indicate that sex-hormones especially estrogen and GPER-1 might have a potential role in the etiopathogenesis of otosclerosis. This is the first study in the literature that investigates the GPER-1 values in otosclerosis.

Does Type 2 Diabetes Mellitus Affect the Healing of Bell's Palsy in Adults?

OBJECTIVES: Bell's palsy (BP) is defined as an acute facial weakness of unknown cause. Many factors affecting the healing of BP have been identified; 1 factor commonly considered relevant is the presence of type 2 diabetes mellitus. Our aim was to investigate the effects of diabetes on the healing of BP. METHODS: Sixty patients with BP were followed up for 1 to 3 years and were divided into 2 groups, those with and those without type 2 diabetes. All were prescribed prednisone (initially 1 mg/kg per day, with a tapered dose reduction) and acyclovir (200 mg orally every 4 h, 5 times daily, for 5 days). Their recovery times were compared. RESULTS: The healing times of the patients with and without diabetes did not differ. CONCLUSIONS: Diabetes does not affect the severity, recovery rate from or healing of BP.

The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery.

To investigate the effects of surgery type [intact canal wall (ICW) or canal wall down (CWD) mastoidectomy] and different ossiculoplasty materials on hearing outcome in single-staged cholesteatoma surgery. A retrospective case-control study. A total of 116 cases (97 adults, 29 children) underwent surgery, including ossiculoplasty, between 2012 and 2015 for cholesteatoma. Patients who had undergone surgery for the first time, and whose grafts were successful, were included in the study. Patients with adhesive otitis media, unsuccessful grafts, revision and recurrent cases, radical mastoidectomy, and craniofacial anomalies were excluded. Audiogram examinations of the enrolled patients were performed 3-6 months after surgery, and the audiometric results were analyzed according to the criteria of the American Academy of Otolaryngology, Head and Neck Surgery. All ossiculoplasties were performed during the first operation. The preoperative average air-bone gap (ABG) of the patients was decreased from 31.37 ± 10.1 to 27.42 ± 10.4 dB; this decrease was found to be highly significant (p = 0.0001). Concerning the ICW technique, statistical evaluation of the hearing gain at frequencies of 500, 1000, and 2000 Hz, as well as the mean frequency, showed a high level of significance. Improvement at 4000 Hz was not found to be statistically significant. When the ABGs at 500, 1000, 2000, and 4000 Hz, and the mean frequency in patients with an hydroxyapatite-partial ossicular replacement prosthesis (HA-PORP) or autograft-partial ossicular replacement prosthesis (APORP), were evaluated, it was found that, at 4000 Hz, the APORP significantly reduced the ABG (p = 0.02). No significant difference was determined between patients with the hydroxyapatite-total ossicular replacement prosthesis (HA-TORP) and those with the autograft-total ossicular replacement prosthesis (ATORP) (p = 0.565). Although the use of the malleus as an APORP was found to be less effective than other autografts, the degree of advantage of using the incus, malleus, cortical bone, and cartilage did not significantly differ between materials (p = 0.152). Despite the effects of the incus, malleus, and cortical bone not differing in terms of the postoperative ABG (p = 0.160), incus usage was highly beneficial for hearing gain (p = 0.009). Despite CWD tympanoplasty affecting all frequencies, it has a particularly negative effect on the hearing threshold at 1000 Hz. In patients with partial ossicular replacement, autogenous grafts are more successful in restoring hearing at high frequencies, particularly at 4000 Hz. Although autogenous materials do not differ in terms of partial replacement effectiveness, the incus has been shown to be most effective for total replacement.

Effects of polymer-based, silver nanoparticle-coated silicone splints on the nasal mucosa of rats.

Infection is a serious complication after nasal packing that otolaryngologists seek to avoid. The aim of this study is to investigate the use of silver (Ag) nanoparticle, which serves as antimicrobial agents, with nasal tampons. The study design is an experimental animal model and the setting is tertiary referral center. Twenty-four rats were randomized into the following four groups: (1) control group (n = 6); (2) silicone nasal splint (SNS) group (n  =  6); (3) polypropylene-grafted polyethylene glycol (PP-g-PEG) amphiphilic graft copolymer-coated SNS group (n  =  6); and (4) Ag nanoparticle-embedded PP-g-PEG (Ag-PP-g-PEG) amphiphilic graft copolymer-coated SNS group (n  =  6). These tampons were applied to rats for 48 h, after which they were removed in a sterile manner, and the rats were sacrificed. The nasal septa of the rats were excised, and assessments of tissue changes in the nasal mucosa were compared among the groups. The removed tampons were microbiologically examined, and quantitative analyses were made. When the groups were compared microbiologically, there were no significant differences in bacterial colonization rates of coagulase-negative Staphylococcus spp. among the three groups (p = 0.519), but there was a statistically significant difference among bacterial colonization rates of Heamophilus parainfluenzae and Corynebacterium spp. (p = 0.018, p = 0.004). We found that H. parainfluenzae grew less robustly in the Ag-PP-g-PEG than the PP-g-PEG group (p = 0.017). However, we found no significant difference between the Ag-PP-g-PEG and SNS groups, or between the SNS and PP-g-PEG groups. The growth of Corynebacterium spp. did not differ significantly between the Ag-PP-g-PEG and SNS groups (p = 1.000). When Group 4 was compared with Group 2, the former showed less inflammation. Compared with other tampons, Ag-PP-g-PEG amphiphilic graft copolymer-coated silicone nasal tampons caused less microbiological colonization and inflammation. Therefore, the use of these tampons may prevent secondary infections and reduce the risk of developing complications by minimizing tissue damage.

Difficult septal deviation cases: open or closed technique?

INTRODUCTION: The aim of this study is to compare the functional aspects of open technique (OTS) and endonasal septoplasty (ENS) in "difficult septal deviation cases". METHODS: 60 patients with severe nasal obstruction from S-shaped deformities, multiple deformities, high deviations etc. were included in the study. The OTS was used in 30 patients and the ENS was performed in 30 patients. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at first month following surgery. Patients were also evaluated for pain postoperatively with Visual Analog Scale (VAS). RESULTS: The mean NOSE score was decreased 62.5-11.0 in the OTS group and 61.3-21.33 in the ENS group. Improvement of the symptoms following the two surgical techniques is similar and no statistically significant difference was found between both techniques. Also there was no statistically significant difference in postoperative pain between the OTS and ENS groups evaluated by VAS. CONCLUSION: ENS is as successful as the OTS in management difficult septal deviation cases. In patients with severe septal deformities type of the surgical technique should be selected according to the surgeon's experience and the patient's preference.

Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy.

OBJECTIVE: To assess pretreatment levels in the counts and percentages of leukocytes and the neutrophil-lymphocyte ratio (NLR) in benign and malignant salivary gland tumors (SGTs) while investigating whether NLR is an inflammatory marker for distinguishing low- from high-grade parotid gland tumors. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: This study was performed on 182 patients with SGTs (age range: 16-87 years; 93 male and 89 female) who were treated between January 2010 and May 2015. Pretreatment counts and percentages of leukocytes and NLR were measured preoperatively in benign and malignant tumors. RESULTS: Mean neutrophil percentage (63.50% ± 12.11% vs 58.76% ± 8.20%, P = .008) and NLR (3.29 ± 3.13 vs 2.13 ± 1.26, P = .008) were significantly higher in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte count (2.42 ± 0.72 103/mm3 vs 1.97 ± 0.87 103/mm3, P < .001) and percentage (30.67% ± 7.68% vs 26.86% ± 10.15%, P = .011) were lower in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte percentage and NLR were significantly different between low- and high-grade malignant parotid gland tumors (P = .026 and P = .030, respectively). CONCLUSION: Elevated NLR could be an inflammatory marker to distinguish low- from high-grade malignant parotid gland tumors.

Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management.

Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature.

Role of Chlamydia pneumoniae and Helicobacteria pylori in the development of tympanosclerosis.

The etiology of tympanosclerosis (TS) is not known, but TS commonly develops secondary to acute and chronic otitis media (COM). Since calcification process in TS resembles that of atherosclerosis (AS), pathogens that are related to pathogenesis of AS may be involved in development of TS. This prospective and controlled study, performed at a tertiary referral center, investigated a possible relationship between the presence of Chlamydia (C.) pneumoniae and Helicobacter (H.) pylori and the development of a tympanosclerotic plaque. The presence of C. pneumoniae was examined in the surgical specimens of 62 patients (29 females and 33 males; age range 10-70 years, mean age 30.8 ± 13.3 years), including 30 patients with TS, 14 patients with cholesteatoma, and 18 patients with chronic suppurative otitis media (CSOM). The presence of H. pylori was examined in the surgical specimens of 88 patients (41 females and 47 males; age range 6-70 years, mean age 32.5 ± 14.8 years), including 35 patients with TS, 22 patients with cholesteatoma, 20 patients with CSOM, and 11 patients with otosclerosis. Tympanosclerotic plaques and control specimens from the cholesteatoma, polypoid mucosa, or mucosal portion of the perforations and stapes supra structure were examined for the presence of H. pylori and/or C. pneumoniae using real-time polymerase chain reaction analysis. The analysis demonstrated that specimens from the tympanosclerotic plaques and the other types of COM were all negative for C. pneumoniae and H. pylori. An association between C. pneumoniae or H. pylori infection and the development of TS or other types of COM could not be established.