Effects of Hyperbaric Nitrogen Narcosis on Cognitive Performance in Recreational air SCUBA Divers: An Auditory Event-related Brain Potentials Study.

BACKGROUND: The narcotic effect of hyperbaric nitrogen is most pronounced in air-breathing divers because it impairs diver's cognitive and behavioral performance, and limits the depth of dive profiles. We aimed to investigate the cognitive effects of simulated (500 kPa) air environments in recreational SCUBA divers, revealed by auditory event-related potentials (AERPs). METHODS: A total of 18 healthy volunteer recreational air SCUBA divers participated in the study. AERPs were recorded in pre-dive, deep-dive, and post-dive sessions. RESULTS: False-positive score variables were found with significantly higher differences and longer reaction times of hits during deep-dive and post-dive than pre-dive sessions. Also, P3 amplitudes were significantly reduced and peak latencies were prolonged during both deep-dive and post-dive compared with pre-dive sessions. CONCLUSION: We observed that nitrogen narcosis at 500 kPa pressure in the dry hyperbaric chamber has a mild-to-moderate negative effect on the cognitive performance of recreational air SCUBA divers, which threatened the safety of diving. Although relatively decreased, this effect also continued in the post-dive sessions. These negative effects are especially important for divers engaged in open-sea diving. Our results show crucial implications for the kinds of control measures that can help to prevent nitrogen narcosis and diving accidents at depths up to 40 msw.

Endoscopic Surgery for Recurrent Disc Herniation After Microscopic or Endoscopic Lumbar Discectomy.

AIM: To determine the feasibility and efficacy of full endoscopic interlaminar discectomy (FEID) for recurrent disc herniation. MATERIAL AND METHODS: This retrospective single-center study included 60 patients. Among them, 36 who previously had microdiscectomy underwent revisional FEID (MD group), and 24 who previously had FEID underwent revisional FEID (FEID group). In addition to general parameters, the following measurement tools were used: visual analog scale (VAS) and Oswestry disability index (ODI) questionnaire. RESULTS: No statistically significant difference was observed in length of hospitalization, time to return to work, complications, and recurrences between the two groups. Both the FEID and MD groups had a significant decrease in postoperative VAS and ODI scores. The mean operation time was shorter in the FEID group than in the MD group, and the result was significantly different (p < 0.05). During the 36-month follow-up, no significant differences were observed in postoperative VAS and ODI scores between the two groups. Moreover, none of the patients developed complications correlated to surgery. However, three patients with a previous history of microdiscectomy or endoscopic discectomy had recurrence despite revisional endoscopic surgery. CONCLUSION: Percutaneous revisional full endoscopic lumbar disc surgery is a safe and effective procedure that does not cause additional structural damage. Full endoscopic technique can be used safely for recurrent disc herniations regardless if a patient underwent microscopic or endoscopic surgery.

Fully endoscopic interlaminar and transforaminal lumbar discectomy: clinical results of 857 surgically treated patients.

Minimally invasive surgical techniques are becoming increasingly common in spinal surgery in an attempt to decrease tissue trauma during surgery, which in turn decreases post-operative pain and opioid use. The aim of this study was to investigate the clinical outcomes of a large group of patients with lumbar disc disease who underwent full endoscopic surgery. 857 patients who underwent fully endoscopic lumbar discectomy were investigated retrospectively. General demographics were evaluated in terms of mean operating time, mean length of hospital stay, mean time to return to work, complications and recurrences. Clinical outcomes were evaluated using visual analogue scale (VAS) for low back and leg pain, and Oswestry Disability Index (ODI) for functional assessment. The mean follow-up time was 36 months. The operation time ranged from 20 to 65 minutes (39 min on average), and there was no measurable intraoperative blood loss. Patients were mobilised on average 3.5 hours after the surgery. The length of hospital stay after the operation was 12-24 hours (18 hours on average). During postoperative follow-up, 19 patients required revision surgery due to recurrence (2.2%). There was one case of nerve root injury in which the patient recovered well following physical therapy, and 11 cases of paresthesia that gradually improved following 2-6 weeks of rehabilitation and treatment with pregabalin. All types of lumbar disc herniations are accessible via the full-endoscopic technique. Full-endoscopic discectomy, as a minimally invasive procedure, has the technical advantages of less paraspinal muscle dissection, less tissue trauma, less risk of spinal instability, and minimal blood loss.

Exogenous Cushing syndrome due to misuse of potent topical steroid.

We report an infant with exogenous Cushing syndrome after being treated for 2 months with a potent topical corticosteroid via the mother's application of topical clobetasol for diaper rash without a prescription. We emphasize that potent topical steroids should be used with great caution, especially when used under occlusion (e.g., diaper area) and that parents should be warned about potential side effects of these medications, particularly when used in infants.

Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model.

INTRODUCTION: Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. OBJECTIVE: The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. METHODS: Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n=4), and percutaneous osteotomy (8 bones) in Group 2 (n=4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. RESULTS: In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. CONCLUSION: Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.

The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.

The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.

The efficacy of vestibular electrical stimulation on patients with unilateral vestibular pathologies.

OBJECTIVES: This study aims to investigate the efficacy of vestibular electrical stimulation (VES) in unilateral vestibular lesions including benign paroxysmal positional vertigo (BPPV). PATIENTS AND METHODS: Between June 2007 and August 2007, a total of 19 patients diagnosed with BPPV were included in this study and they were randomized into two groups using the 1:1 method. Ten patients were administered medical treatment plus VES (treatment group; 1 male, 9 females; mean age 55.8 years; range 27 to 74 years), whereas nine patients were only administered medicine (control group; 2 males, 6 females; mean age 54.9 years; range 34 to 73 years). Both groups received the same medical treatment throughout the study. Vestibular electrical stimulation was performed for 30 min long twice a day, three times a week; 12 sessions in total with 80 Hz high-frequency Transcutaneous Electrical Nerve Stimulation (TENS). Before and after the treatment, patients' severity of dizziness was assessed with Visual Analog Scale (VAS) and daily life activities with Dizziness Handicap Inventory (DHI), and their duration (sec) of single leg stance with eyes open and closed was recorded. RESULTS: Compared to prior to the treatment, VAS-dizziness and DHI scores, and the duration of single leg stance on one foot with eyes open and closed at the end of the treatment showed statistically significant improvement in both groups; however, although VES provided a positive contribution, we did not find a statistically significant difference between the two groups. CONCLUSION: It can be concluded that VES has positive contribution to medical treatment of patients with dizziness due to unilateral vestibular lesions; however the results of this study should be further investigated with larger groups of patients.

Extended lateral thoracic fasciocutaneous biosynthetic flap for reconstruction of full-thickness partial external ear defects: an experimental study.

External ear reconstruction is a controversial topic in reconstructive plastic surgery. Here, we prepared a pedicled biosynthetic flap for full-thickness, partial ear defects in rabbits. We operated on six adult female New Zealand rabbits weighing 3-4 kg. The dimensions of the lateral thoracic fasciocutaneous flap were 7 × 6 cm. The flap was elevated based on one of the bilaterally located internal thoracic arteries, which were dissected proximally. The pedicled flap was folded in two, and polypropylene mesh was sandwiched in the middle. The flap was adapted to a defect of 3.5 × 3 cm in diameter. In fact, the defect was created before elevation of the flap. Rabbits were followed up for 4 weeks, at the end of which they were killed and their ears were evaluated histopathologically. The survival rate of the rabbits was 100 %. All pedicled biosynthetic flaps were viable, but one showed partial (20 %) necrosis (1/6) and one was partially detached (1/6). Macroscopic (color, thickness, texture) and histological (polymorphonuclear leukocyte invasion in the skin, subcutaneous tissue, and at the junction between the polypropylene mesh and the flap) features of the flap were compared to the ipsilateral ear. A new technique was developed for partial external ear reconstruction with sufficient inner skeletal support and outer skin lining. Level of evidence Level NA.

Assessment of inferior turbinate radiofrequency treatment: Monopolar versus bipolar.

OBJECTIVE: The aim of this study is to compare the early results of monopolar (MP) and bipolar (BP) radiofrequency (RF) used in inferior turbinate hypertrophy treatment concerning aspects of patient and surgeon comfort. STUDY DESIGN: Prospective randomized single-blind study. MATERIALS AND METHODS: The study included 71 patients with inferior turbinate hypertrophy resistant to medical treatment. BP RF was applied to 36 patients. MP RF was applied to 35 patients. Patients received no other treatment during their 6 months of follow-up examinations. They were evaluated by their symptoms (nasal obstruction severity, nasal obstruction frequency, postnasal drip, nasal crusting, hyposmia, patient satisfaction, and preoperative pain) with a visual analogue scale (VAS) done preoperatively on the 1st and 7th days and then in the 1st, 3rd, and 6th months postoperatively. RESULTS: No significant difference was observed comparing the symptoms of patients after BP and MP inferior turbinate RF in long-term follow-up, whereas patients treated with MP RF showed early improvement in their symptoms on the 1st and 7th days postoperatively when compared to the BP group. The application time of MP RF was longer than that of the BP group. Pain during the operation was reported more frequently in the BP group. CONCLUSION: MP and BP RF treatment showed no difference in long-term efficacy. However, MP RF therapy showed early improvement in symptoms and less pain in patients than in the BP RF group.

Effects of ozone (O3) therapy on cisplatin-induced ototoxicity in rats.

The aim of this study is to investigate the effect of rectal ozone and intratympanic ozone therapy on cisplatin-induced ototoxicity in rats. Eighteen female Wistar albino rats were included in our study. External auditory canal and tympanic membrane examinations were normal in all rats. The rats were randomly divided into three groups. Initially, all the rats were tested with distortion product otoacoustic emissions (DPOAE), and emissions were measured normally. All rats were injected with 5-mg/kg/day cisplatin for 3 days intraperitoneally. Ototoxicy had developed in all rats, as confirmed with DPOAE after 1 week. Rectal and intratympanic ozone therapy group was Group 1. No treatment was administered for the rats in Group 2 as the control group. The rats in Group 3 were treated with rectal ozone. All the rats were tested with DPOAE under general anesthesia, and all were sacrificed for pathological examination 1 week after ozone administration. Their cochleas were removed. The outer hair cell damage and stria vascularis damage were examined. In the statistical analysis conducted, a statistically significant difference between Group 1 and Group 2 was observed in all frequencies according to the DPOAE test. In addition, between Group 2 and Group 3, a statistically significant difference was observed in the DPOAE test. However, a statistically significant difference was not observed between Group 1 and Group 3 according to the DPOAE test. According to histopathological scoring, the outer hair cell damage score was statistically significantly high in Group 2 compared with Group 1. In addition, the outer hair cell damage score was also statistically significantly high in Group 2 compared with Group 3. Outer hair cell damage scores were low in Group 1 and Group 3, but there was no statistically significant difference between these groups. There was no statistically significant difference between the groups in terms of stria vascularis damage score examinations. Systemic ozone gas therapy is effective in the treatment of cell damage in cisplatin-induced ototoxicity. The intratympanic administration of ozone gas does not have any additional advantage over the rectal administration.

Indirect laryngoscopic assessment for the diagnosis of difficult intubation in patients undergoing microlaryngeal surgery.

BACKGROUND: The aim of this study is to investigate the feasibility of using indirect laryngoscopy for the diagnosis of difficult intubations in patients who are undergoing microlaryngeal surgery. METHODS: In the pre-anesthetic examination the thyromental distance, sternomental distance, interincisor distance, neck circumference, modified Mallampati scores, and Wilson risk scores were measured. An otolaryngologist conducted an indirect laryngoscopic assessment. Direct laryngoscopic profiles were classified according to their Cormack-Lehane scores. RESULTS: Forty patients underwent microlaryngeal surgery. Their mean ages, neck circumferences, Cormack-Lehane scores of the patients who had intubation difficulties were statistically significantly higher than those who did not have intubation difficulties (p < 0.05). The significant differences between the indirect laryngoscopic assessment distributions of patients who either had or did not have intubation difficulty were assessed (p < 0.05). CONCLUSIONS: Indirect laryngoscopic assessment is a simple and valuable technique that can be used for the diagnosis of difficult intubation in patients who are undergoing microlaryngeal surgery.

Comparative assessment of monopolar and bipolar radiofrequency surgery of inferior turbinate.

OBJECTIVE: The aim of this study was to compare early outcomes of monopolar (MP) and bipolar (BP) radiofrequency (RF) treatment of inferior turbinate hypertrophy from the perspective of both the patient and the surgeon. STUDY DESIGN: Prospective, randomized, single-blind study. MATERIALS AND METHODS: Seventy-one patients with inferior turbinate hypertrophy resistant to medical treatment. BP RF was used in 36 patients and MP RF in 35 patients, respectively. Patients received no other treatment during a 6-month follow-up. They were evaluated for symptoms such as nasal obstruction severity, nasal obstruction frequency, postnasal drip, nasal crusting, hyposmia, patient satisfaction, and preoperative pain with the use of a visual analogue scale (VAS) before surgery and then 1 and 7 days as well as 1, 3, and 6 months after surgery. RESULTS: No significant difference was observed regarding symptoms of patients after BP and MP inferior turbinate RF surgery in a long-term follow-up. Patients treated with MP RF showed early symptom improvement on days 1 and 7 days after surgery compared to the BP group. Procedure duration of MP RF was longer than that of BP RF. Pain during surgery was reported more frequently in the BP group. CONCLUSION: MP and BP RF treatment showed no difference in long-term efficacy. However, MP RF therapy was associated with early symptom improvement and less pain reported by patients in comparison to the BP RF group.

Foramen Magnum Decompression and Duraplasty is Superior to Only Foramen Magnum Decompression in Chiari Malformation Type 1 Associated with Syringomyelia in Adults.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To compare surgical results of foramen magnum decompression with and without duraplasty in Chiari malformation type 1 (CM-1) associated syringomyelia (SM). OVERVIEW OF LITERATURE: The optimal surgical treatment of CM-1 associated with SM is unclear. METHODS: Twenty-five cases of CM-1 with SM were included. There were 12 patients (48%) in the non-duraplasty group and 13 patients (52%) in the duraplasty group. The rate of improvement, state of postoperative SM size, amount of tonsillar herniation, preoperative symptom duration, complications and reoperation rates were analysed. RESULTS: The rate of clinical improvement was significantly higher with duraplasty (84.6%) than without (33.3%, p <0.05). The rate of postoperative syrinx regression was significantly higher in the duraplasty group (84.6%) than in the non-duraplasty group (33.3%, p <0.05). One case in the duraplasty group needed a reoperation compared with five cases in the non-duraplasty group (p =0.059). CONCLUSIONS: Duraplasty is superior to non-duraplasty in CM-1 associated with SM despite a slightly higher complication rate.

A case of sinonasal paraganglioma with a different morphology: nine-year follow-up.

Paragangliomas are very occasionally located in the nasal cavity. In this article, we present a 32-year-old female case with a sinonasal paraganglioma with atypical histopathological morphology. In our case, sinonasal paraganglioma consisted of lipoblast-like vacuolated cells instead of the typical Zellballan histological pattern. The prognosis of a nasal paraganglioma is not very clear. The present article is important, as it describes the first case report of a sinonasal paraganglioma with atypical lipoblast-like vacuolated cells with a nine-year follow-up.

Extended Endoscopic Endonasal Approach to the Third Ventricle: Multimodal Anatomical Study with Surgical Implications.

INTRODUCTION: A certain interest for the extended endoscopic endonasal approach for the management of sellar-suprasellar lesions extending inside the third ventricle has been growing in recent years. The aim of this anatomical study was to evaluate the possibilities in terms of exposure and access to the different areas of the third ventricle, with the endoscopic endonasal technique, as compared with the microscopic or endoscopic view provided via different transcranial approaches. The advantages and limitations of both surgical pathways were analyzed. MATERIALS AND METHODS: Ten human cadaver heads were dissected. In order to standardize the comparison between the endonasal and the transcranial routes, the third ventricle cavity has been divided into four areas by means of two ideal planes, one passing through the optic chiasm and the interthalamic commissure and one passing through the posterior edge of the foramen of Monro and the interthalamic commissure. Accordingly, two anterior (infundibular and foraminal) and two posterior (mesencephalic and tectal) areas have been defined. RESULTS: The endoscopic endonasal approach allows for exploration and surgical maneuverability, especially in the anterior areas of the third ventricle. In the infundibular and foraminal areas the surgical maneuverability seems to be better as compared with that obtained inside the mesencephalic region, while via the endonasal route the tectal area could not be reached. In particular, the infundibular area can be explored either passing through the lamina terminalis or via the tuber cinereum; this latter trajectory enables visualization of the foramina of Monro and the floor of the third ventricle up to the pineal recess. CONCLUSION: This anatomical study shows that the lamina terminalis and, above all, the tuber cinereum represent two safe entry points defining possible surgical corridors to be considered for the extended endoscopic endonasal approach to the third ventricle.

Metastatic follicular thyroid carcinoma masquerading as olfactory neuroblastoma: with skull-base, cranium, paranasal sinus, lung, and diffuse bone metastases.

Skull-base metastasis is rarely reported in thyroid carcinoma. We are presenting an unusual interesting case mimicking metastatic renal cell carcinoma with intense clear cell morphology, the thyroid origin of which was detected via positron emission tomography/computerized tomography scan proposed by the oncology council, while we were monitoring the subject with the initial diagnosis of paranasal sinus tumor. A mass was detected in the left nasal cavity in the endoscopic examination of the 68-year-old female patient referred by the ophthalmology clinic with the preliminary diagnosis of retro-orbital tumor upon being admitted with proptosis. A soft tissue lesion at a size of 68 × 39 × 53 mm located intracranially was detected by the brain computerized tomography. The biopsy taken and the immunohistochemical results were not satisfactory. Intense fluorodeoxyglucose involvement was observed in both lobes of the thyroid gland at positron emission tomography/computerized tomography taken with the recommendation of the council. Moreover, hypermetabolic nodules were seen in both lung parenchyma areas, whereas intense hypermetabolic lytic lesions were observed in the skeletal system. Thyroglobulin and thyroid transcription factor 1 stains displayed a strong staining on paraffin block. On the basis of these characteristics, the case was regarded as compatible metastatic follicular thyroid carcinoma, with skull-base, cranial, retro-orbital, paranasal sinus, lung, and bone metastases. This case showed us that multidisciplinary work and assessment of the oncology council play a highly critical role in making the diagnosis and guiding the treatment.

Fully Endoscopic Interlaminar Detethering of Spinal Cord in Tethered Cord Syndrome: A Case Report and Technical Description.

A 19-year-old man presented with long lasting significant back and bilateral leg pain, and hypoesthesia on the lateral side of both his thighs for which he had undergone several courses of medication and bouts of physical therapy treatment. His urodynamic parameters were normal and lumbar magnetic resonance imaging (MRI) revealed a low-lying conus at the L2-3 level with a thickened fatty filum, and he was diagnosed as having tethered cord syndrome (TCS). The patient underwent a fully endoscopic detethering through an interlaminar approach with intraoperative neurophysiological monitoring. The thickened filum terminale was located and then the filum was coagulated and cut. The patient showed a significant improvement in his preoperative symptoms, and reported no problems at 2-year follow-up. Detethering of the spinal cord in tethered cord syndrome using a fully endoscopic interlaminar approach provides the advantages of minimal damage to tissues, less postoperative discomfort, early postoperative recovery, and a shorter hospitalization.

The analysis of the maxillary sinus volumes and the nasal septal deviation in patients with antrochoanal polyps.

The aim of this study was to evaluate the relationship between the maxillary sinus volumes and the nasal septal deviation angles in patients with antrochoanal polyps (ACP). 76 patients who underwent ACP surgery were included in the study. Of those 36 patients who had multislice computed tomography (MSCT) were evaluated to calculate maxillary sinus volume. The records of paranasal MSCT of 36 healthy people without any paranasal sinus diseases or surgery constituted age- and gender-matched healthy controls. Maxillary sinüs volumes and septal deviation angles were calculated using the paranasal MSCT volume-rendering technique. Thirty-six patients in the ACP group were compared with 36 polyp side-matched healthy people. The mean age was 16.6 ± 6.7 years in both groups. Statistically, the mean value of the maxillary sinus volume was significantly higher in the ACP group compared with the ACP side-matched control group (15.1 ± 4.6 versus 12.0 ± 3.5 mm(3)) (p = 0.002). Furthermore, the mean value of the maxillary sinus volume in the non-polyp side (14.2 ± 4.7 mm(3)) was statistically higher in the ACP group compared with the side-matched control group volume (11.9 ± 3.8 mm(3)) (p = 0.024). In addition, Fifty-three of 76 ACP patients had septal deviation. While the septal deviation was on the same side with the ACP in 17 patients, it was on the opposite side in 36 patients. In conclusion, the maxillary sinus volumes increased in ACP patients compared with the healthy control group. Many patients had nasal septal deviation on the opposite side of the ACP.

Infectious and Noninfectious Causes of Epiglottitis in Adults, Review of 24 Patients.

OBJECTIVE: The present study reports the etiological differences, clinical features, management, and patient outcomes between infectious and noninfectious causes of epiglottitis in adult patients. METHODS: The medical records of 24 patients with infectious and noninfectious epiglottitis were investigated. Diagnosis was made by anamnesis and endoscopic examination. On admission, respiratory distress of patients was classified according to Freidman's classification. RESULTS: Fifteen patients were male, and nine patients were female. Their ages ranged between 24 and 69 years of age (mean, 43.4±11.6). In total, 16 patients were diagnosed with infectious epiglottitis, and eight patients were diagnosed with noninfectious epiglottitis. Of patients with noninfectious epiglottitis, two had angioedema, two had experienced organophosphate ingestion, one had experienced hot water aspiration, one had experienced hot milk aspiration, one had experienced foreign body aspiration (fishbone), and one had epiglottitis due to Behçet's disease. Sore throat was the most common symptoms of infectious and noninfectious epiglottitis in our patients. Odynophagia was the second most common symptom of infectious epiglottitis, and muffled voice was the second most common symptom in noninfectious patients. CONCLUSION: Epiglottit is an emergency situation; when a patient is diagnosed with epiglottitis, close follow-up should be performed, and airway support should properly be maintained according to the degree of respiratory distress. Tracheostomy should be performed without hesitation, as needed.

Evaluation of Inner Ear Damage by Using Otoacoustic Emissions in Patients Who Underwent Mastoidectomy and Tympanoplasty Operations in the Early Period.

OBJECTIVE: We aim to demonstrate inner ear damage caused by drilling in the early period. Healthy contralateral ears of patients who underwent mastoidectomy using drill or tympanoplasty without using drill were compared. METHODS: A total of 38 patients (mastoidectomy: 22, tympanoplasty: 16) who were diagnosed as chronic otitis media and were scheduled for surgery were included. Distortion product (dp) otoacoustic emissions measurements were performed on healthy contralateral ears of patients on pre- and post-operative 1. hour, 1. day, 2. day, 3. day, and 4. day. RESULTS: In mastoidectomy group, dp otoacoustic emission values on post-operative 1. hour, 1. day, 2. day, 3. day, and 4. day at a frequency of 4000 Hz were significantly lower than in tympanoplasty group (p<0.05). In mastoidectomy group, dp values on post-operative 1. hour, 1. day, 2. day, 3. day, and 4. day at 4000 Hz significantly decreased in comparison with pre-operative period (p<0.05). In comparison with pre-operative period, decrease in dp values on post-operative 1. hour, 1. day, and 2. day at 4000 Hz in mastoidectomy group is significantly higher than those in tympanoplasty group (p<0.05). In tympanoplasty group, dp values on post-operative 1. hour at 4000 Hz significantly decreased in comparison with pre-operative period (p<0.05). CONCLUSION: Drilling used in mastoidectomy operation damage healthy contralateral ears by causing acoustic trauma. This damage can be determined by otoacoustic emissions in the early period. According to our study, hearing loss is temporary and more distinct at higher frequencies.