Do Decreased Mastoid Pneumatization, Bilateral Involvement and Eustachian Tube Function Affect the Success of Type 1 Tympanoplasty?

Aim: The surgical success rate of tympanoplasty appears to be influenced by a number of variables. Eustachian tube dysfunction has been shown as one of the factors causing failure in tympanoplasty. It is known that bilateral disease and decreased in mastoid pneumatization are associated with Eustachian tube (ET) dysfunction. In this study, the relationship between the success of type 1 tympanoplasty and mastoid pneumatization, bilateral disease and ET function was investigated. Materials and Methods: A total of 44 patients who were operated for chronic otitis media in our clinic were included. The information of the patients was obtained retrospectively, the direction of the disease (bilateral/unilateral), the status of the graft (intact/perforated), mastoid pneumatization status, and hearing levels (preoperative/postoperative 6th month) were noted. Automatic Williams test was used to tympanometrically evaluate ET functions (ETF) in postoperative period. The relationship between tympanoplasty success and mastoid pneumatization, bilateral disease and ETF was investigated by statistical analysis. Results: The disease aspect was found bilateral in 34.1% (n = 15) of the cases, and unilateral in 65.9% (n = 29) of the cases. Mastoid pneumatization was decreased in 52.2% (n = 23) of the cases, and normal in 45.4% (n = 20). The preoperative air-bone mean difference (gap) of the cases with decreased mastoid pneumatization was found to be statistically significantly higher than the cases with normal mastoid pneumatization (p < 0.05). The closure of the postoperative air-bone gap in patients with unilateral disease direction was found to be statistically significantly higher than in patients with bilateral disease direction (p < 0.05). Also we found significantly worse ET functions both in unilateral and bilateral disease. Conclusion: Preoperative air-bone gap average is higher in ears with decreased mastoid pneumatization, and postoperative air-bone gap closure is higher in unilateral patients. Mastoid ventilation does not make a significant difference in the success of type 1 tympanoplasty. On the other hand, our results support that ET dysfunction can be effective in the occurrence of chronic otitis media (COM).

Effect of Supporting Anterior Tympanomeatal Angle with Temporofacial Graft in Type 1 Tympanoplasty on Hearing Results and Graft Success in Early Period.

The treatment of persistent tympanic membrane perforation is tympanoplasty. Presence of perforation in the anterior annulus of the patients undergoing tympanoplasty surgery is a commonly encountered problem in the postoperative period. In this study, we investigated the effects of supporting anterior tympanomeatal angle with a secondary layer of temporal muscle fascia graft in the patients undergoing type 1 tympanoplasty on postoperative hearing outcomes and early graft success. Twenty-seven patients from our clinic who underwent surgery due to chronic otitis media (COM) and whose anterior tympanomeatal angles were supported with temporal muscle fascia graft as a secondary layer were included in the study. Twelve of the patients were male and 15 of them were female. The mean age of the patients was 43,1 years. The data obtained with retrospective investigations of the patient files were statistically analyzed. Audiological results of 27 patients were obtained in the postoperative 3rd month and were compared with the preoperative results. Preoperative pure tone average of bone-conduction and air conduction were 14,68 ± 7,08 dB and 41,63 ± 9,83 dB, respectively. Postoperative pure tone averages of bone-conduction and air conduction were determined to be 15,02 ± 6,40 dB and 26,38 ± 12,79 dB, respectively. The grafts of all patients were intact at the postoperative 3rd month. We can describe the technique we used as modified sandwich tympanoplasty. In this study we found that in patients that undergoing type 1 tympanoplasty, supporting the anterior tympanomeatal angle with temporal muscle fascia graft as a secondary layer is successful in terms of hearing outcomes and graft success.

The Effect of Hormone Replacement Treatment on Hearing Function in Hypothyroid Patients.

Congenital hypothyroidism causes physiologic, morphologic and developmental abnormalities of the auditory system. However, the effect of acquired hypothyroidism and hormone replacement treatment (HRT) on hearing function is still controversial. This study aimed to investigate hearing impairment and the effect of HRT on hearing function in patients with acquired hypothyroidism. MATERIALS AND METHODS: Fifty hypothyroid patients were included in this study. Levothyroxine (0.05-0.2 mg/dl) was used for HRT and its dosage was gradually increased until the patients became euthyroid. Otoscopy and microscope was used to evaluate tympanic membrane and hearing thresholds and pure tone avarages (PTA) were estimated by using pure tone audiometry before and after treatment. RESULTS: Patients with lower baseline free T4 (FT4) had significantly higher air conduction PTA (p < 0.05). Negative correlation between the severity of hypothyroidism and hearing gain were found (p < 0.05). Hearing improvements were at 250 and 8000 Hz after HRT. CONCLUSION: Due to the correlation between baseline FT4 and hearing impairment in a negative direction, disease severity may have an effect on hearing impairment. In addition, patients with lower FT4 and higher thyroid-stimulating hormone levels had lower PTA improvement after HRT. HRT may not significantly improve hearing disorders in severe hypothyroidism.

Adenotonsillar Hypertrophy: The Relationship Between Obstruction Type and Attention in Children.

We aimed to investigate the attention function, which is a parameter of cognitive functions, at different obstruction types (adenoid and tonsil hypertrophy, adenoid hypertrophy only, tonsillar hypertrophy only, and normal) of oral cavity and nasopharynx, and the relationship between obstruction level, type, and attention (N = 80). To evaluate attention function, Stroop test has been performed. Eighteen-item Quality of Life (OSA-18) and Brouillette Symptom Score questionnaires have been completed with each child's parents. Significant and positive relation has been found between Brouillette Symptom Score, OSA-18 score, and each 5 sections of Stroop test's points. It has been shown that children with adenotonsillar hypertrophy (ATH) are negatively affected in terms of obstructive symptoms and quality of life. At the situation of obstructive pathology, the Stroop test durations are affected negatively. Results are supporting that quality of life and attention parameter are affected negatively at children with ATH.

A New Biomarker on Bone Resorption in Chronic Otitis Media: Osteoprotegerin and NLRP3 Inflammasome Gene Polymorphisms.

Chronic Otitis Media (COM) is a chronic inflammation of the middle ear and mastoid with persistent membrane perforation and hearing loss. Osteoprotegerin (OPG) and NOD like receptor protein 3 (NLRP3) play an important role in bone metabolism. The aim of the study was to investigate the role of OPG and NLRP3 gene polymorphism on ossicular chain resorption in COM. Fourty COM patients and 20 healhty control group were included in the study. While 20 patients underwent ossiculoplasty, 20 patients underwent type 1 tympanoplasty. DNA was isolated from peripheral blood using the DNA kit. OPG gene c.226A > C (p.Thr76Pro) and NLRP3 gene c.592G > A (p. Val198Met) polymorphisms were genotyped using melting curve analysis technique. NLRP3 gene polymorphism were determined in 6 of 20 patients (30%) in ossiculoplasty group, 4 of 20 patients (20%) in type 1 tympanoplasty group and 3 of 20 patients (15%) in control group. OPG gene polymorphism were determined in 5 of 20 patients (25%) in ossiculoplasty group, 3 of 20 patients (15%) in type 1 tympanoplasty group and 1 of 20 patients (5%) in control group, respectively. There was no statistically significant difference between groups regarding to results. Although the difference was not significant NLRP3 and OPG gene polymorphisms were higher in the ossiculoplasty group. Since NLRP3 and OPG gene polymorphisms were determined to be higher numerically in the ossiculoplasty group, OPG and NLRP3 gene regulation system may have an effect on ossicular chain destruction in COM.

Histopathological changes of parotid and larynx in hypothyroid rats: experimental study.

OBJECTIVES: In this study, we aimed to investigate the laryngeal and parotid histopathological alterations in rats with experimentally induced postnatal hypothyroidism. MATERIALS AND METHODS: 200-300 g weighed Wistar albino rats were included in this study. The rats were randomly divided into four groups: group 1 is control and the other groups are experimental groups. Food and water were supplied ad libitum in group 1, no medication was administered. Propylthiouracil (PTU) was administered intraperitoneally for 15 days in group 2; for 30 days in group 3, for 45 days in group 4. The larynx and parotid glands of the rats were removed and intracardiac blood samples were collected for thyroid-stimulating hormone (TSH) analysis under anesthesia (ketamine hydrochloride, 100 mg/kg) 24 h after the last PTU injection. The same procedures were done for the control group at day 46. Histopathological evaluation was done for all the specimens. RESULTS: While submucosal vascular dilatation was significantly higher in the experiment groups (p < 0.05), there was not a significant difference in lamina propria edema, inflammation, goblet cell loss, cilia loss between the groups in larynx specimens. In parotid gland specimens, serous asinus atrophy, stromal connective tissue increase were significantly higher in experiment groups (p < 0.05). In addition, there was a significant difference in nuclear morphology between control and experimental groups (p < 0.05). CONCLUSION: The results of the study showed that hypothyroidism may have effect on inflammatory procedure by causing vascular dilation in larynx and serous asinus atrophy nucleus changes, connective tissue increase in stroma in parotid gland.

Investigation of Astaxanthin Effect on Cisplatin Ototoxicity in Rats by Using Otoacoustic Emission, Total Antioxidant Capacity, and Histopathological Methods.

BACKGROUND: Cisplatin-induced ototoxicity is related to oxidative stress. Astaxanthin is one of the most powerful antioxidants in nature. AIMS/OBJECTIVES: To investigate the protective effect of astaxanthin on cisplatin-induced ototoxicity. MATERIALS AND METHODS: Thirty-five Sprague Dawley female rats were divided into 5 groups: control, cisplatin, and cisplatin with 10, 20, and 40 mg/kg astaxanthin groups. Cisplatin group received a single intraperitoneal injection of 14 mg/kg cisplatin. While saline was administered in the control group, in the other 3 groups, 10, 20, and 40 mg/kg daily doses of astaxanthin were administered through orogastric cannula before administration of cisplatin. Baseline and 10th day otoacoustic emission tests were administered. An intracardiac blood sample was taken to measure total antioxidant capacity (TAC), and the cochleas of the animals were investigated histopathologically. RESULTS: Hearing level of astaxanthin 40 mg/kg + cisplatin group was higher at 24 kHz and 32 kHz frequencies compared to the cisplatin group. The TAC value of the cisplatin group was lower than both the control and astaxanthin + cisplatin groups (P < .05). On histopathological examination, the other groups were deformed compared to the control group, but no statistically significant difference was observed between the astaxanthin + cisplatin and cisplatin groups. CONCLUSIONS AND SIGNIFICANCE: Astaxanthin showed protective effect at high frequencies when it was administered at high dose. Thus, astaxanthin may have protective effect against cisplatin-induced ototoxicity.

Association between occurrence of ossicular chain defect and osteoprotegerin gene expression in patients with chronic otitis media.

OBJECTIVE: Chronic otitis media (COM) is an important debilitating public problem causing hearing loss due to irreversible resorption of the ossicular chain. Activation of osteoprotegerin (OPG) during an acute attack of COM prevents bone resorption.The aim of the study was to investigate the role of OPG gene expression level on ossicular chain resorption in chronic otitis media. MATERIALS AND METHODS: Fifty operated COM patients were included in the study. While 20 patients underwent ossiculoplasty, 30 patients underwent type 1 tympanoplasty. For RNA isolation and OPG gene expression analysis, middle ear swabs were taken from nasopharynx in the ostium of the Eustachian tube. RNA was isolated with mRNA easy kit and kept at - 85 °C till the cDNA and expression analysis. Expression levels were analyzed with real-time quantitative PCR in comparison with PDGB gene expression level as an internal control. RESULTS: Sample Cq measurements of type 1 tympanoplasty group were higher than Cq measurements of the internal control group (p = 0.027; p < 0.05). In contrast, there was no statistically significant difference between sample Cq measurements of ossiculoplasty group and Cq measurements of the internal control group (p = 0.293; p > 0.05). CONCLUSION: Since OPG gene expression level was significantly higher in type 1 tympanoplasty group, OPG gene regulation system may have an effect on ossicular chain destruction in COM.

Early effects of irradiation on laryngeal mucosa in a gastroesophageal reflux model: an experimental study.

OBJECTIVE: The aim of this study was to evaluate the early histopathological changes of gastroesophageal reflux and irradiation on laryngeal mucosa in rats. STUDY DESIGN: Animal study. SETTING: Experimental animal laboratory, tertiary referral center. SUBJECT AND METHOD: Twenty-four adult female Wistar Albino rats were grouped as: control (n = 6), reflux and irradiation (n = 10), and irradiation (n = 8). Rats were operated to create a reflux model 30 days before irradiation. Ionizing radiation was administered in a single fraction of a 20 Gy to the larynx. Laryngeal tissue samples were taken at the 4th day of irradiation and all specimens underwent histopathological examination. RESULTS: Edema and vascular dilation in lamina propria were higher in the reflux and irradiation, and irradiation groups than control group. Inflammation was higher in the reflux and irradiation group than the control group. Inflammation in squamous epithelium was higher in the reflux and irradiation and irradiation groups compared to the control group. Inflammation in the squamous epithelium of the irradiation group was higher than the reflux and irradiation group. In the respiratory tract epithelium, inflammation was higher in the reflux and irradiation group; additionally, a significant loss of cilia was present in the reflux and irradiation and irradiation groups while pseudostratification was higher in the reflux and irradiation group. CONCLUSION: Ionizing radiation-induced inflammation may increase on previously inflammated area due to gastroesophageal reflux. Therefore, it may be helpful to investigate and treat the reflux in laryngeal cancer patients that will receive ionizing radiation.

The effects of lipoic acid and methylprednisolone on nerve healing in rats with facial paralysis.

OBJECTIVE: To investigate the effects of lipoic acid and methylprednisolone on nerve healing in rats with traumatic facial paralysis. MATERIALS AND METHODS: The rats were randomly divided into four groups, with six rats in the control group and eight each in the remaining three groups. The buccal branch of the facial nerve in all groups except the control group was traumatized by a vascular clamp for 40 minutes. Group 1 was given lipoic acid (LA), Group 2 was given methylprednisolone (MP), and Group 3 was given lipoic acid and methylprednisolone (LA + MP) for one week. Nerve stimulus thresholds were measured before trauma, after trauma and at the end of the one week treatment period. RESULTS: When the groups were compared with each other, post-treatment threshold levels of LA + MP were significantly lower than LA. Although post-treatment threshold levels of LA and MP were still higher than the control group, there was no significant difference between LA + MP and control values (p > .05). CONCLUSION: Lipoic acid has a positive effect on nerve healing and can enhance the effect of methylprednisolone treatment. It is a good alternative in cases where methylprednisolone cannot be used.

Links and risks associated with adenotonsillectomy and obesity.

Adenotonsillectomy (A&T) is a very common surgical procedure in children. Over the past 20 years the principal indication for A&T in children has changed from recurrent adenotonsillitis to obstructive sleep apnea. The physiopathology of obstructive sleep apnea syndrome (OSAS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. On the other hand, the prevalence and severity of childhood obesity have become a veritable epidemic problem in the past 30 years. So the increasing prevalence of obesity in children and high prevalence of obstructive sleep apnea in obese children implies that an increasing number of these children will present for A&T. Due to more prevalent anatomical alterations of the oronasopharyngeal airways, it is often difficult to predict operation success in obese children. However, previous studies supports that although the risk of presence of residual symptoms of OSAS and airway-related perioperative complication in obese may be more than nonobese group, A&T is effective to reduce obstructive symptoms and improve quality of life in obese children with OSAS.

Association of COL1A1 polymorphism in Turkish patients with otosclerosis.

OBJECTIVE: To evaluate the role of COL1A1 gene polymorphism in the etiology of otosclerosis. MATERIAL AND METHODS: Peripheric blood samples are obtained from 28 patients diagnosed with otosclerosis and 50 control subjects. DNA's of all samples are isolated and amplified by using the PCR technique. The products are restricted by appropriate enzymes and the allele distributions were compared. RESULTS: SS (homozygous normal), Ss (heterozygous mutant) and ss (homozygous mutant) alleles of the otosclerotic and control subjects were significantly different from each other. CONCLUSION: Otosclerosis is a disease with progressive hearing loss. There are viral, hormonal, immunologic and genetic hypothesis of etiology. In this study, we concluded that the polymorphism seen in the COL1A1 gene resulting in production of excessive type 1 collagen, could play a role in the pathogenesis of otosclerosis.

A comparison of incidence of Frey's syndrome diagnosed based on clinical signs and Minor's test after parotis surgery.

OBJECTIVES: This study aims to investigate whether postoperative follow-up period, clinical signs or Minor test is effective to determine the incidence of Frey's syndrome following superficial parotidectomy. PATIENTS AND METHODS: Between January 2005 and December 2008, 30 patients, (16 males, 14 females; mean age 47.7±15.3 years, range 17 to 76 years) who underwent superficial parotidectomy in the Ear, Nose, Throat Clinic, were retrospectively analyzed. All patients were administered a questionnaire on clinical signs of Frey's syndrome and disease period, and Minor's test. RESULTS: The postoperative pathological examination showed pleomorphic adenoma, Whartin's tumor, basal cell adenoma and oncocytoma. The Minor's test result was positive in 50% of the patients. While 10% of the patients complained about excessive sweating requiring no treatment, none of them complained about the bad body odor. The disease was considered moderate based on the severity of the disease in all patients. CONCLUSION: The incidence of Frey's syndrome may vary according to the postoperative follow-up period and the diagnostic method applied, including assessment of clinical signs and Minor's test.

Analysis and comparison of changing in thyroid hormones after percutaneous and surgical tracheotomy.

OBJECTIVES: To evaluate the effect of the surgical and percutaneous tracheotomy on the thyroid hormones and their comparisons. MATERIALS AND METHODS: Between January and May 2010, the surgical and percutaneous tracheotomy had been performed on 40 patients with respiration problems. The thyroid hormone levels were measured just before, after one and three hour of the operation and than these measurements were compared statistically. RESULTS: The effect of the surgical and percutaneous tracheotomy on serum thyroglobulin (TG), free thyroxine (fT4), free triiodothyronine (fT3) and thyroid stimulating hormone (TSH) levels was found statistically significant. CONCLUSIONS: The surgeons should not forget the possible increase of the serum thyroid hormone levels after the surgical and percutaneous tracheotomy because of the systemic effects of thyroid hormones. The patients, especially who have cardiac rhythm problems, should be monitored for a while after these processes because the increase of serum thyroid hormones may cause undesired cardiovascular effects.

Adenotonsillar hypertrophy: correlation between obstruction types and cardiopulmonary complications.

OBJECTIVES/HYPOTHESIS: To evaluate the association of upper airway obstruction (UAO) type and cardiopulmonary complications in children. The effect of obstruction type on quality of life and severity of obstructive symptoms were also investigated. STUDY DESIGN: Cross-sectional study. METHODS: A Brodsky scale and adenoid-nasopharynx ratio (ANR) were used to categorize tonsil and adenoid size, respectively. The patients were divided into four groups according to obstruction type: adenoid hypertrophy only (ANR ≥ 0.63, tonsil grade 1 or 2), adenoid and tonsil hypertrophy (ANR ≥ 0.63, tonsil grade 3 or 4), tonsillar hypertrophy only (ANR < 0.63, tonsil grade 3 or 4), and normal (ANR < 0.63, tonsil grade 1 or 2). Mean pulmonary artery pressure (MPAP), tricuspid annular plane systolic excursion (TAPSE), and right ventricle myocardial performance index (RVMPI) were evaluated for each patient. The obstructive sleep apnea questionnaire (OSA-18) and Brouilette symptom score questionnaire were completed by each child's parents. RESULTS: MPAP was higher in patients with adenoid hypertrophy and adenoid and tonsil hypertrophy in comparison with the normal group. The P values were .079 and .055, respectively, when comparing TAPSE and RVMPI measurents in adenoid and tonsil hypertrophy and normal patients. A significant correlation was found between ANR and MPAP, RVMP, and TAPSE. The patients in the adenoid and tonsil hypertrophy group had the highest Brouilette symptom and OSA-18 scores. CONCLUSIONS: Patients with adenoid and tonsil hypertrophy are at a higher risk for cardiopulmonary complications, poorer quality of life, and more severe UAO symptoms and should have priority for surgical treatment to prevent cardiopulmonary complications.

The role of computed tomography scanning in chronic otitis media.

The purpose of this study was to determine the role of high-definition computed tomography (CT) in chronic otitis media (COM) patients and to present which parameters were useful or misleading for preoperative evaluation for management. Fifty cases of COM that underwent preoperative CT scanning at a tertiary referral center were retrospectively analyzed. Their CT scan reports were compared with the operative findings. The patients had undergone tympanoplasty with or without mastoidectomy for COM between April 2008 and January 2010. Patient charts were used to obtain the necessary data. In 62% (31/50) of cases, the CT scan showed the presence of cholesteatoma. Operative findings revealed cholesteatoma in 61.8% (19/31) of these cases. However, when a bone eroding soft tissue mass involved the epitympanum on CT, the presence of cholesteatoma was observed in 83.3% (15/18) of cases intraoperatively. Cholesteatoma was present in the mastoid or middle ear intraoperatively in 77.7% (7/9) of patients with an external ear bony canal defect found on CT. Despite 89.7, 85.29, and 90% agreement ratios for dehiscence of facial canal, lateral semicircular canal, and tegmen, respectively, CT could not detect dehiscence of these anatomic structures successfully. Based on these results, CT scanning has limitations but is a useful adjunct for the surgical management of COM patients.

Functional capacity of the thyroid autograft and heterograft: An experimental study.

BACKGROUND: The aim of this study was to investigate the functional capacity of thyroid autografts/heterografts in a guinea pig model. METHODS: A total of 24 guinea pigs were divided into 4 groups. Group A had only a thyroidectomy incision, and group B had total thyroidectomy. We performed autotransplantation in group C and heterotransplantation in group D. We monitored the guinea pigs for an 8-week period, with weekly measurements of free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH). At the final stage, the autografts/heterografts were histologically examined. RESULTS: In group B, fT3/fT4 showed a gradual decrease; however, an increase of TSH was noted. In groups C and D, fT3/fT4 showed a gradual decrease, followed by a gradual increase until euthyroid levels; an exact opposite was noted for TSH. In histologic examination, there were functional thyroid follicles in all animals of groups C and D. CONCLUSIONS: The autotransplanted/heterotransplanted guinea pig's thyroid tissue provides adequate thyroid function.

The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: a blind, prospective clinical study.

OBJECTIVES: Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. An adenoid-nasopharynx (A/N) ratio determined by means of lateral cephalometric radiographs has long been used as a diagnostic tool in the assessment of adenoid size. This study was designed to investigate the effect of adenotonsillectomy on insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and correlation between A/N ratio and IGF-I and IGFBP-3 levels. METHODS: Patients (n=48) that had been operated on our clinic with a diagnosis of adenotonsillar hypertrophy between July 2009 and January 2010 were included in the study. The routine ear-nose and throat examination was done in all patients. Blood samples were taken, and lateral cephalometric radiographs were obtained preoperatively and repeated at 6-9 months (mean 7.2 ± 1.0 mo) following tonsillectomy and adenoidectomy. The chemiluminescent enzyme-linked immunosorbent method was used to IGF-I and IGFBP-3 levels. Each cephalometric radiograph was evaluated by a blinded radiologist. The A/N ratio was calculated using the Fujioka method. RESULTS: When the preoperative and postoperative results were compared, a statistically significant increase in serum IGF-I and IGFBP-3 and a decreased A/N ratio were found. However, although correlation between the Δ(preoperative-postoperative difference) IGFBP-3 and ΔA/N ratio was 40%, it was not statistically significant. Additionally, no statistically significant correlation between the ΔIGF-I and ΔA/N ratio was found. CONCLUSIONS: The results of the present study indicate that adenotonsillectomy could result in the relief of nasopharyngeal obstruction and have a positive effect on growth in children by decreasing the A/N ratio and increasing IGF-I and IGFBP-3. There was no correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.

The effects of obstructive sleep apnea syndrome due to adenotonsillar hypertrophy on the cardiovascular system in children.

Obstructive sleep apnea syndrome (OSAS) due to adenotonsillar hypertrophy (ATH) is a common and important problem in children. OSAS can lead to significant cardiopulmonary complications, poor growth and problems with learning and behavior. Many studies in the literature show that OSAS due to ATH causes pulmonary hypertension, ventricular hypertrophy and systemic hypertension in the pediatric population. In this review, we discuss the effects of ATH on cardiac function. It is well known that as a child grows, the nasopharyngeal passage becomes enlarged, helping to improve OSAS. Based on this, we discuss the possible positive effect of this age-related improvement on the obstruction of cardiovascular disturbances. Finally, the possible relationship between the duration of OSAS and the timing of surgery with the permanency of cardiovascular disturbances is discussed.

Effects of ovariectomy and estrogen replacement therapy on laryngeal tissue: a histopathological experimental animal study.

OBJECTIVE: To determine the histopathological effect of estrogen deficiency and hormone replacement treatment on laryngeal tissue in ovariectomized rats. STUDY DESIGN: Animal study. SETTING: The study was conducted at the animal experiment laboratory of Marmara University School of Medicine, Istanbul, Turkey. SUBJECTS AND METHODS: Six-month-old female Wistar albino rats were divided into the following 3 groups (n = 8 per group): sham-operated control, ovariectomized, and ovariectomized with estrogen replacement. Rats in the ovariectomized with estrogen replacement group received 17 ß-estradiol valerate (200 µg/kg, subcutaneously) once a week. Animals were killed after 8 weeks of intervention. RESULTS: Significant changes were observed in the ovariectomized group when edema in lamina propria, inflammation in squamous, respiratory epithelia and lamina propria, pseudostratification, and cilia loss were assessed. Except cilia loss, there were no significant differences in the assessments between the sham-operated control and ovariectomized with estrogen replacement groups. CONCLUSIONS: On the basis of histopathological evaluations, it was shown that estrogen replacement helped to improve laryngeal changes due to experimentally induced menopause.