Surgical and Histopathological Results in Carotid Body Tumors.

OBJECTIVE: The possible relationships between the histopathological findings of carotid body tumors and age, gender, tumor diameter, and Shamblin classification were investigated. In addition, preoperative embolization status, development of neurological complications, need for vascular reconstruction, hemoglobin change, and discharge time were examined and the effects of these variables on each other were analyzed. METHODS: Between 2008 and 2022, 46 cases who underwent carotid body tumor excision were examined retrospectively. The cases were followed for an average of 81 months postoperatively. Histopathological materials were reexamined and the effect of categorical variables was analyzed. RESULTS: Mean tumor diameter was 3.55 ± 1.26 cm, mean discharge time was 3.91 ± 2.37 days, and mean hemoglobin change was 1.86 ± 1.25. Neurological complications developed in 13% of cases. The amount of hemoglobin change was significantly (p = 0.003) higher in those who developed neurological complications, whereas the tumor diameter and discharge time were found to be insignificantly higher. Surgical complications requiring vascular repair occurred in 10.8% of cases. Tumor diameter (p = 0.017) and hemoglobin change (p = 0.046) were significantly higher in these patients. There were significant correlations between higher Shamblin classification and tumor diameter, discharge time, postoperative hemoglobin value, and number of surgical and neurological complications. No significant difference was found between Ki-67, capsular invasion, mitosis, pleomorphism, prominent nucleoli, mean island diameter, and tendency of islands to merge with categorical variables. CONCLUSION: As the tumor diameter increases, the operation becomes more difficult and the postoperative complication rate increases. We think that subadventitial and capsular removal of the tumor is effective in preventing recurrence. To reach a histopathological conclusion, a larger series of studies including tumors with high Ki-67 and mitosis rates, large size, and one or more of the criteria for necrosis are needed.

Comparing Endoscopic Measurements of the Anterior and Posterior Ethmoidal Arteries with CT Measurements: A Cadaveric Study.

OBJECTIVE: To reveal the reliability of radiological measurements of the ethmoid arteries. METHOD: Five fresh frozen cadaveric heads underwent computed tomography and endoscopic sinus surgery. The lateromedial length of the anterior ethmoidal artery (AEA) and its distance to the axilla of the middle turbinate (MTA), the sphenoethmoidal recess (SR) and the posterior ethmoidal artery were measured. The posterior ethmoidal artery (PEA) was referenced to the SR. These anatomical parameters were measured both radiologically and endoscopically, and the compatibility of the two was examined. RESULTS: Ten nasal cavities were dissected. We found that the distance of MTA to the AEA was 16±8 mm in dissection, 21±4 mm radiologically in the sagittal section, the distance of SR to the AEA was 14±3 mm in dissection, 19±4 mm radiologically in the sagittal section, and the distance of the AEA to the PEA was 10±3 mm in dissection, 12±3 mm radiologically in the axial section. The distance of the PEA to SR was 6±3 mm in dissection, 8±2 mm radiologically in the sagittal section. CONCLUSIONS: The distance of the AEA to the MTA, the distance of the AEA to the PEA and the distance of the PEA to the SR were compatible with each other in the dissection and in the radiologically evaluation, whereas the distance of the AEA to the SR was not compatible.

Effectiveness of Spreader Graft Versus Autospreader Flap in Reducing Nasal Air Resistance.

OBJECTIVE: The authors aimed to compare the functional outcomes of 2 different techniques, spreader graft and autospreader flap, by using them for nasal valve surgery in cadavers using acoustic rhinometry (AR). METHOD: Ten frozen cadavers who underwent nasal valve surgery between May 2017 and August 2018 were randomly divided into 2 groups. Spreader grafts were applied to 10 nasal valve regions in 1 group, while the autospreader flap method was used on the other 10 nasal valve regions. The effectiveness of the surgical techniques was evaluated utilizing AR. RESULT: We objectively evaluated the effect of surgery on nasal air resistance by comparing the preoperative and postoperative AR values (MCA1, MCA2, volume) in both the spreader graft and the autospreader flap groups. In addition, the differences in nasal potency gain after the application of both techniques were compared and the superiority of the 2 surgeries in terms of functional gains was evaluated. A statistically significant difference was observed in preoperative and postoperative MCA1, MCA2, and volume values in both the techniques and sides. The authors found more significant nasal valve opening for the spreader graft technique using acoustic rhinometric values when compared with the autospreader flap technique. CONCLUSIONS: In both methods, the air resistance was observed to decrease objectively in the nasal valve region. Autospreader flaps increase the nasal valve angle without the need for additional cartilage tissue, and it could be an alternative to spreader grafts.

The Effect of Rhinoplasty Dissection Planes (Sub-SMAS, Subperichondrial, and Subperiosteal) on the Viability of Diced Cartilage Grafts in a Rabbit Model.

BACKGROUND: Dorsal preservation surgeries in which the subperichondral and subperiosteal planes are used to elevate the soft tissue envelope of the nose have become increasingly widespread because they can reduce postoperative edema and promote faster healing. However, the effects of surgical dissection planes on the viability of cartilage grafts are not known. OBJECTIVE: The aim of this study was to determine, in a rabbit model, the viability of diced cartilage grafts in different rhinoplasty dissection planes (sub-superficial musculoaponeurotic system [SMAS], subperichondral, subperiosteal). METHODS: Diced cartilage samples were placed in the sub-SMAS, subperichondrial, and subperiosteal planes, and after 90 days, histopathologic analysis was performed. Cartilage graft viability was evaluated based on the loss of chondrocyte nuclei in the lacuna, the presence of peripheral chondrocyte proliferation, and the loss of matrix metachromasia in the chondroid matrix. RESULTS: The median [interquartile range] percentages of live chondrocyte nucleus viability in the sub-SMAS, subperichondrial, and subperiosteal groups were 67.5% [18.75%] (range, 60%-80%), 35% [17.5%] (range, 20%-45%), and 20% [30.0%] (range, 10%-45%), respectively; and the percentages of peripheral chondrocyte proliferation were 80.0% [22.5%] (range, 60%-90%), 30% [28.75%] (range, 15%-60%), and 20% [28.75%] (range, 5%-60%), respectively. There was strong statistical significance in both parameters (P = .001). Intergroup examination revealed a difference between the sub-SMAS and the other surgical planes (P = .001 for both parameters). A smaller loss of chondrocyte matrix was observed in the sub-SMAS group compared with the other 2 groups, which supports the findings of cartilage viability (P = .006). CONCLUSIONS: Elevating the soft tissue envelope of the nose in the sub-SMAS surgical plane preserves the viability of cartilage grafts better than subperichondrial and subperiosteal elevation.

vHIT results with the synapsis system according to clinicians' dominant hand use.

BACKGROUND/OBJECTIVE: There exists limited information in the literature on dominant hand preference in relation with vHIT applications. The present study aimed to examine the relationship between the clinician's dominant use of right- or left-hand and vHIT results. METHODS: A Synapsys vHIT Ulmer device was used in the study. The tests were administered by 3 clinicians experienced in vHIT, 2 of whom were right-handed and 1 left-handed. The test was applied to the 94 participants three times, one week apart. RESULTS: In this study, the correlation between right-handed clinicians and left-handed clinicians was examined, and in all SCCs, namely RA, LA, RL, LL, RP and LP, a moderate positive significant correlation was found between right-handed1 and right-handed2, between right-handed1 and left-handed, and between right-handed2 and left-handed. CONCLUSIONS: In this study, these findings suggested that measures were reliable across test sessions regardless of hand dominancy (right or left). Based on the vHIT results we obtained with three different right- or left-handed clinicians, the clinician should evaluate the results according to the dominant side.

Evaluation of the efferent auditory system in COVID-19 adult patients.

BACKGROUND: The short- and long-term effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the medial olivocochlear reflex and outer hair cells in the cochlea remain largely unclear. AIMS: The aim of this study was to investigate the efferent auditory system effects in adult patients with COVID-19. MATERIALS AND METHODS: The study included 18-50 years old 44 volunteers: 26 individuals (52 ears) with COVID-19 in the study group and 18 healthy individuals (36 ears) in the control group. Otolaryngological examination, immitancemetric evaluation, distortion product otoacoustic emission (DPOAE), contralateral acoustic stimulation with DPOAE, audiometric evaluation, and high frequency audiometric evaluation were performed in all individuals participating in the study. RESULTS: In our study, patients with COVID-19 had significantly lower DPOAE results with or without broadband noise at only 6 kHz frequency and contralateral suppression results at all frequencies compared to healthy individuals. A statistically significant difference was found between the study and control groups according to whether the participants had a response in the high frequency audiometry at 12 and 16 kHz frequencies. CONCLUSIONS: COVID-19 affects many systems in the body. As a result of the findings obtained in the present study, it is shown that the auditory efferent system may also be affected.

Endoscopic Anatomy of the Lacrimal Sac: A Cadaveric Study.

OBJECTIVE: To describe the anatomy of the lacrimal sac in relation to the lateral nasal wall by cadaver dissection, and to measure the distances of surgically important landmarks from relevant structures for safer and more efficient surgery. METHOD: A total of 12 endoscopic dacryocystorhinostomy (DCR) were performed on both sides (right and left) of 6 fresh-frozen cadavers. The distances of the lacrimal sac to the posterior edge of the uncinate process, the frontal process of the maxilla, the maxillary ostium, the nasal vestibule, the middle turbinate attachment and the inferior turbinate were measured. In addition, the width and length of the lacrimal sac were measured. RESULTS: The mean width and length of the lacrimal sac were 5.6 mm and 11.1 mm, respectively. The lacrimal sac was located at 15.2 mm from the posterior edge of the uncinate process, at 35.5 mm from the nasal vestibule, at 13.5 mm from the maxillary ostium, at 12.2 mm from the frontal process of the maxilla, at 8.7 mm from the middle turbinate attachment, and at 7.3 mm from the inferior turbinate. CONCLUSION: This study provides additional measurements regarding the lacrimal sac and its relationships with nearby landmarks for use in endoscopic dacryocystorhinostomy. The distances of the lacrimal sac to the nasal vestibule, the uncinate process and the frontal process of the maxilla are not as reliable as the middle turbinate attachment for predicting the anatomic localization of the lacrimal sac during DCR.

Computed Tomography Analysis of Nasal Anatomy in Dorsal Preservation Rhinoplasty.

BACKGROUND: Subdorsal septal resection and radix osteotomy are distinctive surgical steps in preservation rhinoplasty. OBJECTIVES: The aim of this study was to evaluate the nasal bone thickness, the level of the septal bony-cartilaginous junction (K area), and the distances of the frontal sinus and skull base from the transverse osteotomy line in the Turkish population by means of conventional computed tomography (CT). METHODS: A retrospective evaluation was made of 203 consecutive preoperative paranasal CT scans of patients (classified in terms of age and gender) who had undergone rhinoplasty surgery between January 2020 and June 2021. The nasal bone thickness at the medial canthus level, and the distances between the transverse osteotomy line and the K area, the frontal sinus, and the cribriform plate were measured. RESULTS: The mean measurements were similar in terms of age groups (P = 0.402, P = 0.542, P = 0.134 and P = 0.276 for ages 18-30, 30-40, 40-50, and >50 years, respectively). The mean nasal bone thickness and the distance between the transverse osteotomy line and the K area showed statistical significance (P = 0.001 and P = 0.001, respectively). In both genders, the mean distances between the transverse osteotomy line and the frontal sinus and the cribriform plate were similar (P = 0.921 and P = 0.280, respectively). The nasal bone was thinner and the K area position more cephalic in females. CONCLUSIONS: CT plays an important role in preoperative planning. The need for resection of the ethmoid perpendicular bone may be greater in males when lowering the dorsal hump, and hence they may be more prone to skull base complications. It is therefore necessary to be more careful in the surgical stage of subdorsal septal excision in males.

Is there a relationship between causative microorganisms and hearing loss in neonatal sepsis?

BACKGROUND: The aim of the present study was to determine the possible relationship between cultured microorganisms and hearing loss in infants admitted to the neonatal intensive care unit (NICU) who could not pass a standard hearing test. METHOD: The medical records of infants treated at the NICU were retrospectively evaluated. The patients were first divided into two groups, and group 1 was divided into two subgroups: Group 1 included patients with hearing loss accompanied by proven sepsis caused by either gram-negative (group 1A) or gram-positive (group 1B) bacteria, and group 2 included patients with clinical sepsis. The groups were compared with potential risk factors related to hearing loss. RESULTS: Between January 2014 and January 2019, the cases of 3,800 infants admitted to the NICU were reviewed. Of 3,548 living babies, the Auditory Brainstem Response (ABR) test showed that 35 infants (0.98%) were diagnosed with hearing loss. In 12 infants with hearing loss, microbial growth in the blood cultures was detected, whereas in the remaining 23, the blood cultures were negative. Of the cases with microbial growth, five were gram negative and seven were gram positive. In the comparison of groups 1A, 1B, and 2, there were statistically significant differences in terms of risk factors such as low birth weight (p = .048), neonatal hospitalization time (p = .001), free oxygen support (p = .001), intraventricular bleeding (p = .001), loop diuretic use (p = .001), and blood transfusion (p = .048). CONCLUSION: The relationship between hearing loss and microorganisms causing sepsis could not be determined in this research.

Development of Pharyngocutaneous Fistula after Total Laryngectomy: The Predictive Value of C-reactive Protein/Albumin Ratio.

BACKGROUND: We aimed to evaluate whether C-reactive protein(CRP)/ Albumin ratio (CAR) performed in the early postoperative period after total laryngectomy could be a predictive factor for the development of pharyngocutaneous fistula (PCF). METHODS: The files of patients with laryngeal squamous cell carcinoma who underwent total laryngectomy between January 2005 and January 2019 were retrospectively reviewed. Patients were divided into two groups: patients with PCF (PCF group) and without (Non-PCF group). CAR values and risk factors were compared between groups. RESULTS: The overall incidence of PCF was 23.2%. There was a statistically significant difference between the two groups in terms of CRP and CAR levels (p = 0.001). The CAR value of 27.05 (sensitivity = 75.0% , specificity 68.2%, area under curve (AUC) = 0.742, 95% confidence interval 0.616-0.868) was determined as a cutoff value to describe the development of fistula in the early postoperative period. In multiple linear regression analysis, there was an independent relationship between presence of PCF and previous RT and CAR value. CONCLUSIONS: CAR, performed in the early postoperative period, may be a new and useful marker for predicting PCF after total laryngectomy.

The effects of local and intraperitoneal zinc treatments on maxillofacial fracture healing in rabbits.

OBJECTIVE: This study aimed to determine whether administration of topical and intraperitoneal zinc for maxillofacial fractures has any impact on the bone healing process. MATERIAL AND METHOD: Thirty-two New Zealand rabbits were randomly assigned to four groups of eight each. The first group was the control group; fracture lines were fixed using titanium microplates and no medication was administered. The second group received fixations using zinc-coated titanium microplates. A single dose of 3 mg/kg zinc was administered intraperitoneally to the third group following fixations with titanium microplates. A single dose of 3 mg/kg zinc was administered intraperitoneally to the fourth group following fixations with zinc-coated titanium microplates. Zinc coating on to the titanium microplates was achieved using the physical vapor deposition technique. A fracture line was created in the nasal bones of all subjects and fixed with five-hole flat microplates and three 5-mm micro screws. All work groups were sacrificed at the end of the sixth week. RESULTS: Histological examination showed that the number of osteoblasts were significantly higher in zinc-coated group (Group 2) than zinc uncoated, control group (Group 1), (415.6 ± 46.7 vs 366.3 ± 11.8) (p < 0.001). It was observed that intraperitoneal zinc treatment alone (Group 3) did not significantly increase in the osteoblast count compared to zinc un-coated group (Group 1), (390.6 ± 83.2 vs 366.3 ± 11.8), (p = 0.341). The immunoreactivity scores for IGF-1 were significantly higher in the zinc-coated group compared to control group (Group 2 vs 1), (9.3 ± 2.8 vs 3.7 ± 1.9) (p < 0.05). It was observed that intraperitoneal zinc treatment did not cause a significant difference in the aspect of IGF-1 for zinc-coated groups (Group 2 vs 4) (9.3 ± 2.8 vs 9.6 ± 2.2) (p = 0.791). The difference in the immunoreactivity score among whole groups for TGF-ß was not statistically significant (Group 1 vs 2, 3.2 ± 1.7 vs 4.4 ± 2.3, p = 0.256; Group 1 vs 3, 3.2 ± 1.7 vs 3.8 ± 2.8, p = 0.524; Group 1 vs 4, 3.2 ± 1.7 vs 2.8 ± 1.3, p = 0.717; Group 2 vs 3, 4.4 ± 2.3, vs 3.8 ± 2.8, p = 0.610; Group 2 vs 4, 4.4 ± 2.3, vs 2.8 ± 1.3, p = 0.124; Group 3 vs 4, 3.8 ± 2.8, vs 2.8 ± 1.3, p = 0.311). CONCLUSION: The local use of titanium microplates coated with zinc by PVD technique was found effective for fracture healing. Zinc coating of titanium microplates used in fracture treatment can accelerate fracture healing. It may be concluded that clinical studies should be performed now in order to explore if comparable results can be achieved in humans.

Effect of statins on hearing function and subjective tinnitus in hyperlipidemic patients.

INTRODUCTION: It is known that hyperlipidemia reduces hearing functions. In this study, we aimed to study the effect of antihyperlipidemic drugs on hearing functions and tinnitus. METHODS: Eighty-four patients aged 18 to 84, who were diagnosed with hyperlipidemia and started treatment with the statin group (atorvastatin 20 mg and 40 mg, rosuvastatin 10 mg and 20 mg, and simvastatin 20 mg) of antihyperlipidemic drugs, were included in this study. All patients underwent pure-tone audiometry before starting treatment with antihyperlipidemic drugs. Patients with tinnitus were evaluated by Tinnitus Severity Index and Visual Analogue Scale. In the 6th month of therapy, otologic examination, pure-tone audiometry and tinnitus evaluation of the patients were repeated. RESULTS: No significant difference was found in the pure-tone averages of the patients before and after statin use (p > 0.05). However, it was found in the audiometry that, after statin use, all drugs caused to statistically significant decrease in the hearing thresholds at 6000 Hertz (p < 0.05). Also, a strong increase was found in the Speech Discrimination percentages after treatment in patients using rosuvastatin 10 mg (p = 0.022). A significant decrease was found in the tinnitus frequency, duration, severity and degree of annoyance in patients using rosuvastatin 10 mg and 20 mg (p < 0.05). CONCLUSION: Statin group of drugs can have a positive effect on the hearing functions and subjective tinnitus. In particular, it is seen that rosuvastatin group of statins has a more notable effect on tinnitus. It was considered that further studies with larger patient groups are needed.

Prenatal Diagnosis and Intrapartum Management of Congenital Ranula.

A foetal sublingual cystic lesion was diagnosed by routine prenatal ultrasonography at 27 weeks of gestation. Foetal growth and amniotic fluid volume were normal. An ex utero intrapartum treatment (EXIT) procedure was performed, and the cyst was aspirated to allow breathing during planned Caesarean section. The cyst was totally excised when the newborn was 60 days old, and histopathological examination revealed a mucous cyst of the mouth floor.

Anti-inflammatory effects of hyperbaric oxygen on irradiated laryngeal tissues.

INTRODUCTION: To manage the complications of irradiation of head and neck tissue is a challenging issue for the otolaryngologist. Definitive treatment of these complications is still controversial. Recently, hyperbaric oxygen therapy is promising option for these complications. OBJECTIVE: In this study, we used biochemical and histopathological methods to investigate the efficacy of hyperbaric oxygen against the inflammatory effects of radiotherapy in blood and laryngeal tissues when radiotherapy and hyperbaric oxygen are administered on the same day. METHODS: Thirty-two Wistar Albino rats were divided into four groups. The control group was given no treatment, the hyperbaric oxygen group was given only hyperbaric oxygen therapy, the radiotherapy group was given only radiotherapy, and the radiotherapy plus hyperbaric oxygen group was given both treatments on the same day. RESULTS: Histopathological and biochemical evaluations of specimens were performed. Serum tumor necrosis factor-α, interleukin-1ß, and tissue inflammation levels were significantly higher in the radiotherapy group than in the radiotherapy plus hyperbaric oxygen group, whereas interleukin-10 was higher in the radiotherapy plus hyperbaric oxygen group. CONCLUSION: When radiotherapy and hyperbaric oxygen are administered on the same day, inflammatory cytokines and tissue inflammation can be reduced in an early period of radiation injury.

Hookah smoking impairs nasal mucociliary clearance.

INTRODUCTION: Active tobacco smoking has been causally associated with nasal mucociliary clearance (MCC). Smoking through a hookah as an alternative to tobacco smoking has been shown in some scientific studies to have several toxic effects on human health. However, no study has been conducted on the effects on nasal MCC of the hookah as an alternative way of smoking tobacco. The aim of this study is to research whether or not hookah affects nasal MCC. METHODS: The study included 40 subjects in the control group and 38 subjects in the hookah group. The hookah group was divided into two subgroups: those who used hookahs regularly, once every week (N1 group), and those who used hookahs more than once a week (N2 group, of 2 to 5 sessions/week). The N1 group had 20 subjects, while the N2 group had 18 subjects. The MCC test was performed on each subject and results were recorded in minutes. RESULTS: The nasal MCC value in the total hookah group was found to be significantly higher than in the control group (p<0.05). The nasal MCC value of the N2 group that used hookahs more than once a week was significantly higher than those of the control group and N1 group that used hookahs once every week (p<0.05). CONCLUSIONS: Our study has shown that, especially when a hookah was used more than once a week, there was MCC impairment that may put the participant at risk of respiratory tract diseases.

Minimally Invasive Endoscopic Retrosigmoid Approach to the Cerebellopontine Angle Using a Novel Surgical Instrument: A Cadaveric Study.

OBJECTIVES: In this study, we aimed to describe how endoscopes show the neural and vascular structures at the cerebellopontine angle (CPA) through a minimal craniotomy in a well-described anatomic point in the retrosigmoid region and at the same time, evaluate the endoscopic anatomic exposure and maneuverability. We planned to use the new surgical instrument (endoscope cannula), which we designed on fresh frozen cadavers to simulate a real surgical procedure. MATERIALS AND METHODS: The surgical procedure was planned to be performed on 20 sides of 10 fresh cadaver heads. The distance between the asterion and mastoid process was determined, and the midpoint was then marked. From this midpoint, a craniotomy 2 cm in size was posteriorly made. The endoscope cannula together with 0° or 30° endoscopes was inserted to capture the panoramic views of the neurovascular structures in CPA. Endoscopic anatomic exposure and maneuverability were evaluated using 0° and 30° endoscopes with/without the endoscope cannula. RESULTS: The surgeon could easily use both hands during the surgical simulation, and maneuverability was seen to increase in CPA with the use of the endoscope cannula. CONCLUSION: The surgeon can work actively with both hands when the endoscopes and the endoscope cannula are used together. We believe that owing to this, the surgeon's maneuverability would increase and a more effective minimally invasive endoscopic retrosigmoid surgery would ensue.

Can Platelet and Leukocyte Indicators Give Us an Idea about Distant Metastasis in Nasopharyngeal Cancer?

This study aimes to evaluate platelet and leucocyte indicators, such as the mean platelet volume, platelet distribution width, plateletcrit, white blood cell count, neutrophil to lymphocyte ratio in nasopharyngeal cancer patients and also to evaluate the relationship between these indicators and nasopharyngeal cancer with distant metastasis. The medical records of 118 patients diagnosed with nasopharyngeal cancer in our hospital between January 2006 and August 2015 were reviewed. The nasopharyngeal cancer group was further sub grouped according to the presence or absence of distant metastasis and TNM (tumour - T, node - N, metastasis - M) classification. A control group consisted of 120 healthy patients. The platelet and leucocyte values at the time of the initial diagnosis were recorded. Neutrophil to lymphocyte ratio and platelet distribution width values were significantly higher in the nasopharyngeal cancer group. But only platelet distribution width values were significantly higher in the nasopharyngeal cancer group with distant metastasis compared to the nasopharyngeal cancer group without distant metastasis. Neutrophil to lymphocyte ratio and platelet distribution width values may increase in nasopharyngeal cancer. But only the platelet distribution width values may give us an idea about the distant metastasis in nasopharyngeal cancer.

Single seventh day debridement compared to frequent debridement after endoscopic sinus surgery: a randomized controlled trial.

UNLABELLED: The aim of this study was to evaluate the postoperative debridement frequency following endoscopic sinus surgery. Individual randomized controlled trial. Sixty-two adult patients with a diagnosis of chronic rhino sinusitis (CRS) with nasal polyps (NP) and CRS without NP meeting the inclusion criteria were enrolled in this prospective study. The patients were randomized equally to frequent debridement (FD; at postoperative weeks 1, 2 and 4) or to a single debridement (SD; at postoperative week 1) after surgery. The outcomes were assessed with visual analog scale (VAS) for nine main symptoms concerning patient discomfort within the first 4 weeks, with the modified Lund-Kennedy endoscopic score (MLKES) at weeks 4 and 24 and with the sino-nasal outcome test-20 (SNOT-20) at week 24. Thirty-seven of the patients were male, and twenty-five were female. The mean age was 36.1 ± 13.5 in FD group and 39.2 ± 14.7 in SD group. In the SD group, the VAS scores at postoperative week four showed significantly less discomfort at visits (p = 0.004) and less negative effects on their work (p = 0.013). There was no statistically significant difference between the two groups in the week 4 and 24 MLKES and in the week 24 SNOT-20 scores (p > 0.05). The endoscopic findings did not show significant differences between the groups. Our data indicate that FD causes more discomfort at the required visits, more facial pain and more negative effects on patients' work; this method is not superior to postoperative single seventh day debridement in terms of the 24-week quality of life and endoscopic scores. LEVEL OF EVIDENCE: 1b.

Post-traumatic refractory multiple canal benign paroxysmal positional vertigo: a case report.

Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo and is seen in a significant number of patients who present at neurology and ear, nose, and throat clinics. Various maneuvers may be used to determine the affected canal based on observation of specific nystagmus signs, and may also be used for treatment. Multiple canal pathology can make diagnosis and treatment more difficult. Presently described is case of BPPV with multiple canal pathology and traumatic etiology that was resistant to treatment.

Prevalence of otitis media with effusion among school age children in rural parts of Konya province, Turkey.

OBJECTIVES: This study aims to evaluate the current prevalence of serous otitis media (SOM) among school age children living in rural areas of Konya province located in southern Turkey. PATIENTS AND METHODS: This cross sectional study which was conducted between October 2012 and January 2013 included 2,352 children (1,179 males, 1,173 females; mean age 8.9±2.8 years; range 4 to 15 years) who attended 36 different primary schools in rural parts of the Konya province. Otologic complaints, findings, and tympanometry results were recorded. Diagnosis of SOM was obtained based on history, symptoms, abnormal otoscopy and tympanogram findings. RESULTS: The overall prevalence of SOM was 4.6%. The highest prevalence was at the age of four (11.2%). There was a significantly higher prevalence of SOM at the age of six (11.1%). The overall prevalence was higher in males (6.17%) compared to females (3.16%) in all age groups (p<0.05). CONCLUSION: Compared to the literature, overall prevalence of SOM in our study was lower. Development of preventive and therapeutic strategies in the first step health care service may have a considerable effect on this low rate.