The Effect of Endoscopic Endonasal Transsphenoidal Skull Base Surgery on Cochlear Function.

Endoscopic transsphenoidal skull base surgery (ETSS) has become a standard approach in the treatment of sellar and clival lesions, such as pituitary adenoma and chordoma. Due to the close proximity of the clivus and the sella turcica to the inner ear, it is thought that bone drilling in the surgery may have effects on hearing. The aim of this study was to assess the effect of bone drilling in ETSS procedure on cochlear function. This study was performed on 18 patients who underwent ETSS procedure between December 2016 and May 2017. The study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of surgery, type of surgery, preoperative pure-tone audiometry, and preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. Of the DPOAE measurements of the patients who were operated for pituitary adenoma, there was a statistically significant difference between the signal-to-noise ratio (SNR) measurements at 0.5, 1, 2 and 4 kHz ( p < 0.05). Additionally, there were no significant differences in preoperative and postoperative SNR measurements of six patients who were selected for clivus chordoma. When the preoperative and postoperative tonal audiometric tests of the patients were compared, no statistically significant difference was found ( p > 0.05). In conclusion, it is found that bone drilling in ETSS procedure has a negative effect on cochlear function in the early period. This is the first study to evaluate the degree of noise-induced cochlear damage in patients who were gone under ETSS procedure.

Comparison between Rescue Flap and Double Flap Technique.

Objectives Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Design Prospectively randomized study. Setting Tertiary academic center. Participants Sixty patients underwent endoscopic endonasal pituitary surgery. Main Outcomes and Measures Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Results Pre- and postoperative mean VAS scores were 71.67 ± 11.47 and 67.67 ± 9.71 mm in the intact septum group and 77.67 ± 14.06 and 62.67 ± 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. Conclusions This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.

Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty.

Background: There is not an ideal tympanomeatal flap incision type for transcanal procedures. Aims/Objectives: Comparing the outcomes and feasibility of posteriorly and anteriorly based tympanomeatal flap incisions for anterior perforations in endoscopic transcanal cartilage tympanoplasty. Material and methods: Twenty-six patients who had anterior TM perforation were included. Patients were divided into two groups with randomization. All of the data were prospectively collected. These included demographic data, date of the surgery, mean surgery time, preoperative and postoperative sixth-month pure-tone audiometry (PTA), type of tympanomeatal flap incision and graft healing success. Results: Mean follow up time was 20.69 ± 5.03 months. Graft healing rate was 100% in both groups. There was no major complication in both of groups. Mean air bone gap level improvement of (dB HL) at all frequencies was 7.69 ± 2.83 dB HL in group 1 and 7.98 ± 3.08 dB HL in group 2 respectively. Regarding pre-and postoperative mean air bone gap levels and mean surgery times, there was no significant difference between groups (p>.05). Conclusions and significance: For non-complicated anterior perforations that are less than 50% of TM, endoscopic transcanal cartilage tympanoplasty using anterior tympanomeatal flap elevation procedure was seemed minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.

Transcutaneous Suture Tip Plasty: The Technique and Outcomes.

PURPOSE: Radical resections and invasive techniques have been mostly replaced with more conservative techniques. The aim of this study was to assess the objective and the subjective functional and aesthetic outcomes of transcutaneous suture tip plasty. METHODS: A total of 20 patients were included in the study. Patients were treated with transcutaneous suture tip plasty. Functional results were assessed with pre- and postoperative 6-month Sino-Nasal Outcome Test (SNOT-22) and acoustic rhinometry. The pre- and postoperative 6-month mean values of first minimal cross-sectional area (MCA1), second minimal cross-sectional area (MCA2), the distance from the tip of the probe to the first minimal cross-sectional area, the distance from the tip of the probe to the second minimal cross sectional area, nasal volume 1, and nasal volume 2 were measured. Facial analysis was made with the Rhinobase software, designed for facial analysis. RESULTS: The mean pre- and postoperative SNOT-22 scores were 25.55 ± 6.64 and 15.70 ± 8.11, respectively (P < .05). The mean pre- and postoperative nasolabial angles were 82.26º ± 5.69º and 101.47º ± 7.70º, respectively (P < .05). The mean pre- and postoperative nasofrontal angles were 144.30º ± 3.81º and 138.25º ± 3.26º, respectively (P < .05). The mean pre- and postoperative nasal length was 54.22 ± 4.62 mm and 49.95 ± 2.75 mm, respectively (P < .05). The mean pre- and postoperative tip projection was 25.77 ± 3.64 mm and 28.40 ± 2.97 mm, respectively (P < .05). Only postoperative MCA2 values on the right and left side were significantly different from preoperative MCA2 values (P < .05). None of the remaining postoperative acoustic rhinometry scores significantly differed from preoperative scores. Two patients (10%) required revision at around 1 month after surgery due to suture loosening and breakage. CONCLUSIONS: Especially in the era of minimal invasive surgery, transcutaneous suspension tip plasty is promising, with rapid and reliable functional and cosmetic results. Further studies with longer follow-up durations are needed to assess the long-term outcomes of this technique.

Giant Cell Tumor of the Temporal Bone and Skull Base: A Case Report.

Giant cell tumor (GCT) is a benign tumor that originates from undifferentiated mesenchymal cells of the bone marrow. The cranium as well as temporal bone is a rare location for GCTs. Despite its benign nature, GCT may be locally aggressive and has the potential to recur locally. Furthermore, GCT may give rise to pulmonary metastases (~1%) in addition to causing local bone destruction. Surgical excision is the treatment of choice for patients with GCT. We describe the case of a 56-year-old female who presented with headache and hearing loss with extensive GCT, which originated in the squamous part of the temporal bone and extended into the left mandibular fossa and middle ear. She was treated by total resection of the tumor using left temporal craniotomy approach. In this article, we present a case of temporal bone GCT with its clinical features as well as a review of the related literature.

Butterfly Cartilage Tympanoplasty Long-term Results: Excellent Treatment Method in Small and Medium Sized Perforations.

OBJECTIVES: The aim of this study was to evaluate and report the long-term results of the butterfly cartilage tympanoplasty. Short-term and long-term hearing outcomes were compared according to age and perforation location as well. METHODS: Ninety-three patients who were diagnosed with noncomplicated chronic otitis media and underwent microscopic transcanal butterfly cartilage tympanoplasty due to anterior, posterior, and central tympanic membrane perforation were included. Age, gender, follow-up time, pre- and postoperative pure tone audiometry thresholds (both air and bone conduction), pre- and postoperative air-bone gaps (ABGs), if any residual perforation was noted. RESULTS: At the end of the follow-up period, successful closure occurred in 88 of 93 patients and success rate is 94.6%. In all patients, including those with residual perforations, the mean preoperative bone conduction threshold was 15.9 dB (range, 5 to 50 dB) among all groups whereas mean air conduction threshold was 36.4±15.1 dB (range, 10 to 90 dB) preoperatively and 28.8±14.3 dB in 6th month follow-up and 24.9±14.1 dB 24th month follow-up. Preoperative mean ABG was 22.1±7.1 dB (range, 5 to 40 dB) whereas 13.3±5.9 dB 6 months after surgery and 11.9±5.5 dB 24 months after surgery. There was a significant difference between pre- and postoperative ABG in both 6th and 24th month follow-up (P6 mo-24 mo<0.05). Furthermore, preoperative mean air conduction differed significantly from postoperative 6th and 24th month follow-up mean air conduction thresholds (P<0.05). CONCLUSION: We suggested that butterfly cartilage tympanoplasty can be safely performed in small, moderate, and even large perforations, as the hearing outcomes and successful closure rate are similar to those of other surgical methods. Moreover, it can be performed under local anaesthesia and it has low complication rates.

Pediatric type 1 cartilage tympanoplasty outcomes: A comparison of short and long term hearing results.

OBJECTIVE: Tympanoplasty is a commonly used procedure in children as in adults. The purposes of this study were to evaluate and report the long term results of type 1 cartilage tympanoplasty in pediatric population. Short term and long term hearing outcomes were compared according to age and perforation location. METHODS: We retrospectively evaluated a total of 76 of 93 patients who had regularly come to visits (38 male and 38 female) with chronic otitis media (COM) and who were younger than 16 years (range, 9-16 years) and underwent a primary type 1 tympanoplasty in tertiary medical center. We divided our population into 2 groups; a younger group (age <12 years) and an older group (age ≥12 years). Age, gender, follow-up time, prior to surgery and at postoperative 6th and minimum 48th month follow-up pure tone audiometry (PTA) thresholds and if any residual perforation were noted. RESULTS: Successful closure occurred 74 in 76 patients and success rate was 97,03%. The mean 6th month follow-up bone conduction threshold values were 7,61±3,89 and 6,89±6,28 <12 years old and ≥12 years old children, respectively. The mean 48th month follow-up bone conduction threshold values were 6,93±4,00 and 7,12±6,40, <12 years old and ≥12 years old children, respectively. The mean 6th month follow-up air conduction threshold values were 23,75±8,38 and 24,73±10,41 <12 years old and ≥12 years old children, respectively. The mean 48th month follow-up air conduction threshold values were 17,15±6,04 and 20,30±10,30, <12 years old and ≥12 years old children, respectively. Among all children; preoperative mean air conduction differed significantly from postoperative 6th and 48th month follow-up mean air conduction thresholds (p<0.001). They had significant improvement in their ABG compared with their preoperative ABG scores. In addition according to groups, there was no significantly difference between pre and postoperative ABG improvement in both 6th and 48th month follow-up between <12 years old and ≥12 years old patient group. CONCLUSION: In pediatric patients type 1 tympanoplasty with cartilage graft, gives statistically significant success in long term follow up. Long term hearing results of primary type 1 cartilage tympanoplasty is seem to be better than short term hearing results as well. We consider that cartilage graft could be the best graft material for pediatric tympanoplasty for long term success.

Outcome of In Situ Septoplasty and Extracorporeal Subtotal Septal Reconstruction in Crooked Noses: A Randomized Self-Controlled Study.

IMPORTANCE: Severe dorsal deviations in crooked noses are treated by either in situ septoplasty with asymmetric spreader grafts (ISS) or extracorporeal subtotal septal reconstruction (ECS). To our knowledge, except one retrospective study, there is no other that compares the objective and subjective results of these two treatment modalities. OBJECTIVE: The aim of this study was to compare the aesthetic and functional outcomes of ECS and ISS in crooked noses. DESIGN, SETTING AND PARTICIPANTS: This study was carried out on 40 patients (ISS in 20 patients and ECS in 20 patients) who underwent external rhinoplasty surgery due to crooked noses between May 2014 and January 2016. While performing rhinoplasty on the patients, the decision of whether to use the ECS or ISS technique was randomized in a sequential fashion. MAIN OUTCOMES AND MEASURES: Surgical outcomes were assessed and compared using the anthropometric measurement of photographs with Rhinobase software. Subjective assessments of nasal obstruction and aesthetic satisfaction were evaluated with a visual analog scale. RESULTS: There was a significant difference between rhinion deviation angle, supratip deviation angle (SDA) and tip deviation angle pre- and postoperatively in the ECS group, whereas in the ISS group, except SDA, all other postoperative angles were significantly improved from preoperative values (p = 0.218). The nasal tip projection in the ECS and ISS groups was 29.48, 31.5 preoperatively and 29.78, 31.26 postoperatively. The mean postoperative nasal tip projection value (p > 0.005) did not change significantly compared to the preoperative value in both groups. The mean postoperative value of nasolabial (p = 0.226) angle did not change significantly compared to the mean preoperative one in the ECS group. However, in the ISS group, the mean postoperative value of nasolabial (p = 0.001) angle significantly improved compared to the mean preoperative value. There was significant improvement in both groups, while improvements in both functional and aesthetic outcomes were much higher in the extracorporeal group. None of the patients had postoperative nasal obstruction that required revision surgery. One patient underwent revision rhinoplasty due to an irregularity on the nasal dorsum in the ECS group. CONCLUSIONS AND RELEVANCE: This is the first study that compares subjective and objective aesthetic and functional outcomes of crooked nose surgery according to two common septoplasty techniques in a randomized self-controlled fashion. This study was effective in both objectively and subjectively comparing the functional and aesthetic aspect of the patients submitted to two common different techniques of treatment of nasal deviations in crooked nose patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Butterfly cartilage tympanoplasty: an alternative new technique instead of conventional surgery method.

Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small- and medium-sized perforations. There are some difficulties with application of conventional butterfly technique and it affects our success rate of graft healing. With some modifications of graft preparation we can make better success rates. The aim of this study was to present the new renovation of conventional method, describe about what kind of changes we made and its technical facilities about the procedure. The study design is a prospective case series. This study was carried out on 18 patients who underwent inlay butterfly cartilage tympanoplasty with the new technique for anterior and inferior perforations at an otolaryngology department of a tertiary medical center between November 2015 and August 2016. Patients were followed with otoscopy and audiometry, and graft healing's success. Anatomic closure at 6th month after tympanoplasty was found in all 18 patients. There was no incidence of cartilage graft rejection or displacement. Preoperative mean PTA was 27.7 dB, which improved 6 months after surgery to 10.5 dB (the average value of hearing thresholds at 0.5, 1, 2 and 4 kHz). Butterfly cartilage tympanoplasty technique is safe and efficient in terms of both anatomical closure of the defect and improvement in hearing. We believe with this new technique, we facilitate this procedure in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.