Risk of hearing loss in the opposite ear after tympanomastoidectomy.

PURPOSE: The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature. METHODS: The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty. RESULTS: In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear. CONCLUSION: The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery.

Does Obstructive Sleep Apnea Syndrome Have Negative Effects on Hearing?

Introduction: The our aim was to research the occurrence of hearing loss associated with the effect of hypoxemia on inner ear structures owing to sleep apnea syndrome and to designate the timely signs of cochlear injury. Materials and Methods: Participants diagnosed with probable sleep-disordered breathing among 63 patients, who experienced polysomnographic examination, were unexcluded in the present study. Control and study groups were structured in four groups pursuant to the apnea-hypopnea index and an intergroup comparison of audiometric parameters was performed. Accordingly, the apnea-hypopnea index, speech discrimination scores, speech recognition thresholds, and pure tone thresholds were compared. Results: A comparison of the obstructive sleep apnea groups by the degree of hearing loss indicated that there were significant differences by the average pure tone audiometry, average speech recognition thresholds, and average speech discrimination scores in both ears between the four groups (p<0.001). Conclusion: The results of the study proposed that intermittent hypoxemia due to obstructive sleep apnea syndrome might have adverse effects on both the speech discrimination and hearing.

Determining the effect of obstructive sleep apnea syndrome on peripheral vestibular system and hearing.

There have been studies in the literature regarding the effect of obstructive sleep apnea syndrome on hearing function, but studies on the effect of obstructive sleep apnea syndrome on the peripheral vestibular system are limited. The aim of the present study was to determine whether obstructive sleep apnea syndrome causes functional neurological changes, particularly in the peripheral vestibular system, using the video head impulse test. Overall, 57 patients with obstructive sleep apnea syndrome were included; the 'Snorers' group comprised 20 volunteers diagnosed with simple snoring in the polysomnography test. The severity of apnea was assessed by monitoring cardiac and respiratory functions during sleep in both groups. The video head impulse test and audiological evaluations were performed in both groups. Statistically significant differences were found in the cochlea and semicircular canals of our patients in the video head impulse test and audiological battery tests. It may be assumed that decreased blood oxygen concentrations and chronic hypoxaemia have negative effects on the vestibule, cochlear sensory epithelium, and the auditory pathways. We think that inner ear structures and pathways may be affected due to hypoxia in obstructive sleep apnea syndrome. Therefore, screening patients with obstructive sleep apnea syndrome with an audiometry battery may help to detect inner ear pathologies early.

The effects of SARS-CoV-2 on hearing thresholds in COVID-19 patients with non-hospitalized mild disease.

INTRODUCTION: COVID-19 may have many nonspecific symptoms, such as hearing loss, tinnitus and dizziness. This study aims to investigate the effects of SARS-CoV-2 on the hearing thresholds of patients with COVID-19. METHODS: A total of 20 patients aged 20-55 years who were diagnosed with COVID-19 were included in this study. The relationship between the pure-tone thresholds of patients before and after COVID-19 was evaluated. RESULTS: There was no statistically significant difference between bone conduction pure-tone thresholds in all frequencies before and after COVID-19. CONCLUSION: SARS-CoV-2 has no effects on the hearing thresholds in patients with non-hospitalized mild COVID-19 disease. Further studies are needed to investigate the possible effects of SARS-CoV-2 on the auditory system.

The relationship between nasal mucociliary clearance time and the degree of smoking dependence in smokers with obstructive sleep apnea syndrome.

INTRODUCTION: The aim of this study was to investigate the relationship between nasal mucociliary clearance time (NMCT), degree of smoking dependence, cumulative smoking burden and OSAS severity in smokers. MATERIAL AND METHODS: 123 patients (Group 1) with OSAS and 92 healthy controls (Group 2) were included in the study. Group 1 was divided into smokers (Group 1a) and non-smokers (Group 1b). In Group 1a, cumulative smoking burden and Fagerström nicotine dependence test (FNDT) were questioned. Saccharin test was applied to Groups 1 and 2. Student-t, Mann-Whitney-U, Anova, Kruskal-Wallis tests were used to compare the means. RESULTS: NMCT was higher in Group 1 than Group 2 (p = 0.005). The duration of NMCT was higher in Group 1A than Group 1B (p = 0.002). In Group 1a, NMCT values of mild and moderate OSAS patients were longer than in Group 1b (p = 0.02, p = 0.01, respectively). NMCT values of patients with mild dependence were shorter than those with moderate or severe dependence (p = 0.032, p < 0.001, respectively). CONCLUSION: Mucociliary clearance time was higher in smokers with OSAS than non-smokers. While OSAS has a negative effect on mucociliary clearance, smoking also exacerbates the condition.

Evaluation of Hearing Thresholds by Using a Mobile Application in Children with Otitis Media with Effusion.

OBJECTIVE: Otitis media with effusion (OME) is the most common cause of hearing loss in children. Early diagnosis is important as hearing loss affects speech and language development in children. The aim of this study was to compare conventional audiometry with the Android mobile operating system application Hearing TestTM in the evaluation of hearing thresholds in children with OME and to determine the accuracy and reliability of the mobile application. Design and Study Sample: Fifty school-age children aged between 5 and 15 years with OME in at least 1 ear were included in the study. First, hearing thresholds were obtained by conventional audiometric methods and the degree of hearing loss was determined. Then, the hearing thresholds of the patients were measured using the smartphone-based Hearing TestTM application. The data were compared using Cohen's kappa analysis. RESULTS: OME was detected in 88 ears. There was no statistically significant correlation between the hearing threshold results obtained with the mobile phone and conventional audiometry at 500, 1,000, 2,000, and 4,000 Hz. CONCLUSION: The Android mobile phone application Hearing TestTM (version 1.1.3) is not an appropriate screening test to detect hearing loss in children with OME.

Tri-layer Tympanoplasty as a New Technique in High-risk Tympanic Membrane Perforations.

INTRODUCTION: The eradication of the middle ear disease is mentioned as the fundamental principle of tympanoplasty. The presence of some factors related to patient or disease itself forces the physician to classify the chronic ear disease as high-risk perforations. The aim of this study was to present a tri-layer tympanoplasty technique and its otological and audiological outcomes in the ears with high-risk perforations. MATERIALS AND METHODS: This retrospective study was carried out on a total of 46 eligible ears that had chronic otitis media with high-risk perforations. Preoperatively, 17, 15, and 14 ears were reported with Sade classification grade 4 pars tensa retraction (Group 1), total or near-total tympanic membrane perforation (Group 2), and a history of ear surgery (Group 3), respectively. All the cases had tympanoplasty using the tri-layer technique at a tertiary center during 2008 and 2014. A review of the patients' chart showed that 46 patients underwent tri-layer tympanoplasty. Regarding the audiological outcomes, the comparison of pre- and post-operative results revealed mean air conduction level and mean air-bone gap (ABG) of 4 different frequencies in dB according to a new standardized format for reporting hearing outcome in clinical trials. RESULTS: The mean value of the follow-up period was reported as 29.22±3.23 months. Graft take rate was 93.4 % in all the cases, as well as 94.1%, 100%, and 85.7% in Group 1, Group 2, and Group 3, respectively. The mean values of ABG were improved from 35.17±6.64 to 23.52±10.4, 30.46±5.89 to 17.20±8.04, and 29.14±8.37 to 16.14±5.02 dB in Group 1, Group 2, and Group 3, respectively (P<0.05). CONCLUSION: Tri-layer tympanoplasty is a reliable procedure in the surgical treatment of the chronic otitis media with high-risk re-perforations.

Evaluation of nasal mucociliary clearance using saccharin test in smokers: A prospective study.

BACKGROUND AND AIM: Nasal mucociliary clearance time (NMCT) can be measured with the saccharine clearance test which is an inexpensive and easy method. The aim of the present study was to compare and evaluate NMCT using the saccharine clearance test in smokers and non-smokers. MATERIALS AND METHODS: Eighty-five patients whose ages ranged from 18 to 65 years were included in the study. Fifty of the patients were smokers (Group 1) while 35 were healthy, non-smoking volunteers (Group 2). Saccharin clearance test was used to evaluate NMCT in both groups. The results obtained were compared and the statistical analyses were performed using the Statistical Package for Social Sciences (SPSS). RESULTS: NMCT was statistically significantly higher in Group 1 as compared to Group 2 (P < .001, Mann-Whitney U test). However, in cumulative smoking duration (pack-year), Fagerström test values and gender categories, there was no statistically significant difference in the average NMCT values of the two groups (P = .943 vs P = .812 respectively), P = .45). CONCLUSION: Mucociliary activity, the primary defence mechanism of the respiratory epithelium, is significantly depressed in smokers. Our findings showed that the said depression is not associated with the number of cigarettes smoked, duration of smoking or nicotine dependence.

The Effect of Carnitine on Peripheral Nerve Regeneration.

INTRODUCTION: Proximal and distal axons of the nerve body are subject to varying degrees of traumatic degeneration after an incision. The histologic structure of rat peripheral nerves cannot be distinguished from the human. Studies on systemic carnitine treatment following peripheral nerve injury and its positive results are available in the literature. There are no reported results of local administration. METHODS: The authors used 50 rats. A total of 5 groups were created by randomly assigning the rats. In the first study group, the nerve was repaired following the incision. NaCl was locally administered to the repair region. In the second study group, the nerve was repaired following the incision. Carnitine was administered systemically. In the third study group, the nerve was repaired following the incision. The rats were administered Carnitine locally and additionally Carnitine was administered systemically. In the fourth study group, the nerve was repaired following the incision. Carnitine was administered locally. The fifth control group did not undergo any procedure. RESULTS: Although Sciatic function index of the groups that received carnitine was better than the group that received NaCl, no statistically significant difference was present. Nerve action potential amplitude values were calculated from the electrophysiological recordings obtained. All groups were compared among themselves, a statistically significant difference was found. A significant difference was found between first, second, third, fourth, control groups. The total nerve area and number of axons per mm was lower in the control group than all other groups. CONCLUSION: Local administration of carnitine was found to be as effective as systemic administration. The authors therefore conclude that carnitine can be used locally, systemically or systemically + locally to increase regeneration following peripheral nerve damage.

Mulberry hypertrophy and accompanying sinonasal pathologies: A review of 68 cases.

Mulberry hypertrophy occasionally coexists with sinonasal pathologies. There are very few reports in the literature on this clinical entity. We conducted a retrospective study to draw attention to this condition in the context of accompanying sinonasal pathologies. Our study group was made up of 68 patients-51 males and 17 females, aged 13 to 57 years (mean: 34.9)-who had been diagnosed with mulberry hypertrophy and at least one accompanying sinonasal pathology. All patients had a long-standing chronic discharge. Forty-nine of these patients (72.1%) had unilateral mulberry hypertrophy. The most common concomitant pathologies were chronic rhinosinusitis and ostiomeatal complex disease; others included septal deviation, nasal polyposis, allergic rhinitis, and concha bullosa. Thirty-six patients (52.9%) with varying degrees of choanal/nasal obstruction were operated on with endoscopic excision to treat the mulberry hypertrophy. In all, most patients underwent some sort of surgery to treat either the mulberry hypertrophy or the accompanying sinonasal pathology. Based on our findings, we suggest a clinical staging system to serve as a way to standardize management and guide future basic and clinical research.

Does amikacin treatment cause subclinical hearing loss in patients with cystic fibrosis?

INTRODUCTION: Aminoglycosides (AGs) have been widely used for potential life-threatening bacterial infections. Although AGs are well known for their ototoxic side effects, some AGs such as amikacin are considered less harmful to auditory functions; thus, auditory monitoring is mostly neglected during treatment with these drugs. OBJECTIVE: To reflect the potential auditory hazards of repeated amikacin use on the patients with cystic fibrosis (CF). METHOD: 32CF patients with prior exposure to at least 3 courses of amikacin (the CF group) and 35 non-CF patients visiting the outpatient clinic with any complaint other than hearing loss and no history of treatment with any AG(the control, or C group) were compared with pure-tone audiometry(PTA). The diagnosis of CF was made by Nanoduck sweat test. RESULTS: The average age of the participants were 8.25 ± 2.76 years in the CF group and 8.58 ± 2.00 years in the C group (ranging from 5 to 13 years). 29 (43.28%) of the cases were female and 38 (56.71%) were male. Clinical SNHL(sensorineural hearing loss) was detected in 4 of the 32 subjects in the CF group. None of the subjects in the C group exhibited clinical SNHL. There was no statistically significant difference between the groups with regard to presence or absence of clinical SNHL (p > 0.05). However, hearing levels of the CF group were around 20 dB(decibel) HL(hearing loss), whereas hearing levels of the C group were around 5 dB. This difference was statistically significant for the pure tone averages of both all frequencies and speech frequencies (p < 0.05). CONCLUSION: Repetitive exposure to AGs can cause permanent, although mild, sensorineural hearing loss. For prevention, hearing status of the patient should be closely monitored and treatment of choice should be precisely tailored according to the audiological evaluation. This is especially important in patients with CF who frequently experience medical conditions necessitating AGs use.

Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture.

OBJECTIVES: Pharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of 'modified continuous mucosal Connell suture' on the incidence of pharyngocutaneous fistula after total laryngectomy. METHODS: This is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair. RESULTS: Pharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment. CONCLUSION: We defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.

The treatment of neck and parotid gland in cutaneous squamous cell carcinoma of face and forehead and the review of literature.

INTRODUCTION: The treatment of cervical lymph node metastases have a significant prognostic effect on the face and forehead skin cancers. We aimed to point out the importance of loco-regional treatment in cutaneous squamous cell carcinoma of face and forehead. PRESENTATION OF CASE: We present our experience with four cases that had squamous cell carcinoma of face and forehead skin. All cases had regional recurrence following 1-3 years after the primary treatment, but did not have local recurrence. DISCUSSION: Loco-regional lymphatic treatment for face and forehead skin squamous carcinomas has vital importance especially in the cases with high-risk factors for lymph node metastasis. CONCLUSION: Elective lymph node dissection of appropriate region(s) should be included in the treatment plan for cases which have one or more of high-risk factors for lymph node metastases and long-term follow-up should not be ignored.

Atypical presentation of congenital cholesteatoma in an adult case with good hearing result.

INTRODUCTION: Congenital cholesteatoma is thought to be caused by inadequate folding of the epidermoid formation inside the middle ear cleft. During development of the middle ear mucosa, stratified squamous epithelium accumulates in the embryonic life. Its typical appearance is a "pearl" beneath the anterosuperior quadrant of the tympanic membrane. PRESENTATION OF CASE: We report 28 years-old case with congenital cholesteatoma in the posterosuperior quadrant of middle ear cavity. The main complaint was the hearing loss which had developed slowly over several years. DISCUSSION: The case was surgically treated. Postoperative hearing result was satisfactory. CONCLUSION: Congenital cholesteatoma may occur in atypical locations and ages. Many authors prefer canal wall down tympanomastoidectomy. But it can also be treated successfully by intact canal wall tympanomastoidectomy with good hearing results.

Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure.

The aim of this study is to compare the inlay butterfly transcanal cartilage tympanoplasty with the conventional underlay tympanoplasty. Operation time, pre- and postoperative hearing levels, successful closure rate of tympanic membrane (take rate) and long-term re-perforation in dry perforated chronic otitis media were evaluated. The study design consists of case series with a chart review. The study settings are tertiary referral center. Of the 72 patients (age range 14-57 years) with dry perforated chronic otitis media, 29 patients underwent inlay butterfly transcanal cartilage tympanoplasty (group 1) and 43 patients underwent conventional underlay tympanoplasty without mastoidectomy (group 2) between January 2010 and June 2012. The outcome measures were the duration of surgery, "take rate" at the 30th postoperative day and the audiometric results at the 45th postoperative day. Long-term re-perforation was evaluated at least postoperative 1 year. The graft take rate was 96.5 % in group 1 and 90.7 % in group 2 at the 30th postoperative day (p > 0.05). Mean air-bone gap was improved from 18.8 ± 8.09 to 11.9 ± 7.12 dB in group 1 and from 21.9 ± 7.32 to 11.6 ± 8.43 dB in group 2. The improvement of air-bone gap in both groups was statistically significant (p < 0.05) but the improvement between the groups was not statistically significant (p > 0.05). The average duration of the surgery was 29.9 ± 5.38 min for inlay tympanoplasty group and 58.9 ± 12.1 min for underlay tympanoplasty group (p < 0.05). Two patients in group 2 had re-perforations after an initial take of the graft in 1-year follow-up period. Inlay butterfly transcanal cartilage tympanoplasty is a good choice in selected cases. Although this technique has the similar take rate and audiological results with conventional underlay tympanoplasty, it is a time-saving procedure.

Non-Hodgkin lymphoma originating from the frontal sinus.

Primary lymphoma of the paranasal sinuses is a rare entity. Most cases are reported to occur in the maxillary and ethmoid sinuses as well as the nasal cavity. Primary involvement of the frontal sinus is very rare. We report a 68-year-old man with a diagnosis of B-cell lymphoma (non-Hodgkin lymphoma) originating from his frontal sinus.

Topical bupivacaine compared to bupivacaine infiltration for post-tonsillectomy pain relief in children: a prospective randomized controlled clinical study.

The objective of this study is to compare the topical administration of bupivacaine hydrochloride, saline and bupivacaine hydrochloride infiltration on post-tonsillectomy pain in children. Sixty children undergoing tonsillectomy were enrolled in the study. Patients were randomized into three groups using sealed envelopes. Group 1 (n = 20) received topical 0.5 % bupivacaine hydrochloride, group 2 (n = 20) received topical 0.9 % NaCl (saline), and group 3 (n = 20) received 0.5 % bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated using McGrath's face scale. Pain scores in topical bupivacaine hydrochloride group was significantly lesser than the topical saline group at 5th, 13th, 17th and 21st hours, until the 6th day (p < 0.017). Moreover, pain scores of topical bupivacaine hydrochloride group was superior to bupivacaine hydrochloride infiltration group at 5th, 13th, 17th hours and 2nd, 3rd, 4th and 5th day (p < 0.017). There were significantly lesser morbidities in topical bupivacaine hydrochloride than saline group in 1st and 4th day (p < 0.017). Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than bupivacaine hydrochloride infiltration.

Celiac disease and sensorineural hearing loss in children.

CONCLUSION: Sensorineural hearing loss (SNHL) is a neurological situation and celiac disease (CD) may be seen coincidentally. Children with clinical signs of hearing deficiency of unknown etiology should be assessed for CD. OBJECTIVE: CD is a chronic inflammatory gluten-dependent intestinal disease and has extraintestinal findings. The aim of this study was to determine the incidence of CD and SNHL in our pediatric patients. METHODS: A total of 25 pediatric patients (50 ears) with biopsy-proven CD were diagnosed in the pediatric gastroenterology department; 25 healthy control subjects (50 ears) were also included in the study. All subjects underwent pure tone audiometry at frequencies of 250-8000 Hz and tympanometry. RESULTS: In the patients and controls, normal peak compliance, gradient, peak pressure, ear canal volume, and acoustic reflexes were obtained by tympanometry. There was no air-bone gap in any of the participants. There was a statistically significant difference between the audiometric results in the CD and control groups (right ear and left ear) (p < 0.05).