Audiological and transient evoked otoacoustic emission findings in patients with vitiligo.

OBJECTIVE: To investigate hearing loss in patients with vitiligo. STUDY DESIGN: Case-control study. SETTING: University hospital. SUBJECTS AND METHODS: Conventional pure-tone and high-frequency audiometric tests were obtained, and pure-tone average hearing thresholds were calculated for 22 consecutive cases with vitiligo and 22 sex- and age-matched controls. Transient evoked otoacoustic emission testing was also performed. RESULTS: There was sensorineural hearing loss on pure-tone audiogram in 16 (36.4%) ears in patients with vitiligo. The hearing thresholds (in dB) were 16.02 +/- 6.61 versus 12.39 +/- 6.05, 15.68 +/- 6.34 versus 13.18 +/- 3.75, 15.80 +/- 13.93 versus 7.39 +/- 6.95, 25.11 +/- 17.40 versus 15.91 +/- 12.91, 29.89 +/- 18.57 versus 17.84 +/- 12.36, and 45.91 +/- 23.31 versus 33.86 +/- 15.99 in the patient and control groups at 0.25, 1, 4, 8, 10, and 12.5 kHz, respectively, and were statistically significantly different. Reduction of transient evoked otoacoustic emission amplitude was statistically significant at 4 kHz in patients with vitiligo (6.34 +/- 3.98 dB vs 8.63 +/- 5.15 dB, P = 0.023). There was no significant difference in reproducibility, stimulus intensity, stability, and average transient evoked otoacoustic emission amplitudes in patients with vitiligo. CONCLUSION: Hearing thresholds at pure-tone and high-frequency audiometry were higher in patients with vitiligo. Also, significantly lower high-frequency amplitudes were recorded during transient evoked otoacoustic emission testing in the disease group.

Formaldehyde technique in dimensional stability of free fascia: an animal study.

CONCLUSION: Despite the fact that this was a study done with fascia other than the temporalis, we found that non-formaldehyde-formed and formaldehyde-formed fascia graft shrunk by a mean value of 26.5% and 16.7%, respectively, which was statistically significant. This finding might be the explanation for the consistently reported successful outcomes in tympanoplasty carried out with formaldehyde-formed temporalis fascia. However, this study should be validated with autologous human temporalis fascia graft. OBJECTIVES: To determine whether there is any difference in the dimensional stability of free fascia grafts when formed with formaldehyde or not. MATERIALS AND METHODS: In a total of 22 rats, free fascias were prepared with 4% buffered formaldehyde solution in 11 and without formaldehyde in the other 11 rats. All fascia grafts of 1 x 1 cm were implanted under the insicion site of the same rat (autograft). All rats were re-operated after 5 days to measure the dimensions of the grafts. The postoperative changes in the dimensions were calculated. RESULTS: By the 5th day, the mean non-formaldehyde-formed graft surface area was 73.51+/-13.43 mm(2) and the mean formaldehyde-formed graft surface area was 83.28+/-10.50 mm(2) respectively. After 5 days there was a mean decrease in surface area of the non-formaldehyde-formed and formaldehyde-formed grafts of 26.49+/-13.43 mm(2) and 16.72+/-10.50 mm(2), respectively. It was found that formaldehyde-formed fascia exhibited significantly superior dimensional stability when compared with non-fixed fascia during the 5 days of the early healing phase (p=0.031).

Giant retropharyngeal abscess in an adult as a complication of acute tonsillitis: case report.

Retropharyngeal abscess is an uncommon entity that can have severe and even fatal complications if it is not identified and treated early. Clinical and radiologic findings must be considered together prior to surgical drainage of a suspected retropharyngeal abscess. Airway obstruction may require emergent surgical management with tracheotomy. We describe the case of a 22-year-old man with a massive retropharyngeal abscess that was caused by inadequate treatment of acute tonsillitis. He responded well to surgical drainage and empiric antibiotic therapy.

Ex vivo tracheal mucociliary clearance in rats: comparisons of nebulization versus irrigation with lactated Ringer and saline solutions.

OBJECTIVE: This study was performed to compare the effects of isotonic saline, hypertonic saline (buffered/nonbuffered), and lactated Ringer irrigation and distilled water nebulization on mucociliary clearance in ex vivo rats. DESIGN: Experimental study. SETTING: Tertiary otolaryngology care centre. METHODS: Thirty rat tracheas were achieved from 15 rats by dividing the trachea longitudinally into two equal parts. MAIN OUTCOME MEASURES: Mucociliary transport velocity was measured by direct observation of particle placed on the lower end of the trachea after irrigation or nebulization. RESULTS: Significant improvement in mucociliary clearance was found with isotonic saline (p = .002), buffered hypertonic saline (p = .018), lactated Ringer (p = .000), and nebulized distilled water (p = .000) when compared with nonbuffered hypertonic saline. CONCLUSION: Lactated Ringer solution is better than saline solution at enhancing mucociliary clearance, but nebulized distilled water is superior to the tested irrigation solutions in rat tracheal epithelium.

The effect of dacryocystorhinostomy on mucociliary function.

OBJECTIVE: External dacryocystorhinostomy is suspected to cause mucociliary dysfunction by affecting ciliary activity and quality of the mucus. We hypothesized that patients who undergo endoscopic dacryocystorhinostomy may also experience mucociliary dysfunction. We evaluated the effects of surgery on mucociliary clearance time in patients who underwent endoscopic dacryocstorhinostomy and external dacryocstorhinostomy. STUDY DESIGN: A prospective controlled study. SUBJECTS AND METHODS: Forty-four patients were studied: 22 had undergone one-sided endoscopic surgery and 22 had undergone one-sided external surgery for nasolacrimal duct obstruction. Nonoperated sides of the both groups were remained as controls. The saccharin test was used to evaluate the mucociliary clearance time of the both sides. RESULTS: Dacryocystorhinostomy, results in prolonged mucociliary clearance times either endoscopic or external approach is performed (P < 0.001, paired t test). There was no significant difference between the mucociliary clearance times after endoscopic and external dacryocystorhinostomy (P = 0.22, Student's t test). CONCLUSION: Dacryocystorhinostomy impairs mucociliary function independent of the type of surgery.

Prolene: a novel, cheap, and effective material in dacryocystorhinostomy.

CONCLUSION: Prolene is cheap, effective, and readily available in almost all operating theaters. It might be used successfully in endoscopic dacryocystorhinostomy and is promising as an alternative to silicone stent intubations, especially in settings with limited resources. OBJECTIVE: To evaluate the clinical efficacy and results of stenting with polypropylene (Prolene; Ethicon, Inc.) suture material instead of silicone tube in endoscopic dacryocystorhinostomy. PATIENTS AND METHODS: Forty-two endoscopic dacryocystorhinostomy operations were performed in 36 patients (11 men and 25 women; mean age 34.7 + or - 9.5 years, range 16-60 years) between 2007 and 2008. After creating an aperture in the medial wall of the lacrimal sac, 2/0 Prolene was inserted through the canaliculi into the sac. The Prolene was left in the lacrimal sac for 3 months. The patients were followed up for between 6 and 18 months (mean 8.1 + or - 3.6 months). The improvement in the complaint of epiphora was grouped as very good, good, or no change. RESULTS: The improvement in 34 eyes (81%) was reported as very good, whereas improvement was noted as good in 5 eyes (11.9%), and there was no change in 3 eyes (7.1%). We observed granulation tissue formation around the Prolene in two patients.

The effect of anesthetic agents on perioperative bleeding during tonsillectomy: propofol-based versus desflurane-based anesthesia.

OBJECTIVE: Hemorrhage during tonsillectomy is related to the surgical technique, management of bleeding, and choice of anesthetic agent. This study evaluated the effects of anesthetic agents on hemorrhage during tonsillectomy with standardized surgical techniques and management of bleeding. STUDY DESIGN: Double-blind, randomized controlled trial. SUBJECTS AND METHODS: Sixty patients, aged 3 to 12 years, who were scheduled for elective tonsillectomy were enrolled in the study. Propofol-based anesthesia was administered to the first group; desflurane-based anesthesia, to the second. The amount of blood loss due to hemorrhage was measured. RESULTS: Propofol-based anesthesia significantly decreased bleeding during tonsillectomy. CONCLUSION: Propofol-based anesthesia is a reliable method for use in children who undergo tonsillectomy.

Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: a randomized controlled study.

OBJECTIVE: To compare the effects of ropivacaine and bupivacaine on post-tonsillectomy pain in children. METHODS: Forty-six children aged 2-12 years, undergoing tonsillectomy were enrolled in the study. Group 1 (n=16) received bupivacaine, group 2 (n=15) received ropivacaine, and a group 3 (control) (n=15) received 9% NaCl (saline) infiltrated around each tonsil. Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24h postoperatively. RESULTS: No difference was found in the demographic data among the groups. The pain scores were similar between the bupivacaine and ropivacaine groups (p>0.05). The pain scores in both analgesia groups were significantly (p<0.05) lower 1, 4, 12, 16, and 24h postoperatively compared to the control group. Analgesic requirements and the time to first analgesia were also significantly (p<0.05) different between the analgesia and control groups. CONCLUSION: Local ropivacaine infiltration is a safe and effective method and equivalent to bupivacaine for post-tonsillectomy pain.

Laryngopharyngeal reflux in laryngeal cancer.

BACKGROUND/AIMS: Gastropharyngeal or laryngopharyngeal reflux is considered as a factor in various diseases of the larynx and pharynx. The most important consequence of the reflux into the larynx is laryngeal cancer. METHODS: In this prospective study the incidence of gastropharyngeal and laryngopharyngeal reflux in 22 patients with untreated laryngeal cancer was investigated with 24-hour, double probe pH measurements. A group of 25 patients with heartburn and dyspepsia complaints in whom esophagogastroscopy revealed no pathology and for whom 24-hour pH measurement was indicated served as a control group. RESULTS: Two of the 22 patients never smoked and two others had quit smoking 16 and 25 years previously. All four of these patients revealed gastropharyngeal reflux. In total, 14 of the laryngeal cancer patients (63.6%) revealed gastropharyngeal reflux. The rate of gastroesophageal reflux was close among the two groups (50% in the cancer group vs 32% in the control group, p>0.05), but the laryngopharyngeal reflux rate was much higher in the cancer group (63.6% of the cancer patients vs 20% in the control group, p: 0.003). Among the reflux-positive patients and the controls, gastroesophageal reflux rate was higher in the supine position in cancer patients (12.10% vs 6.25, p: 0.02). In the upright position, control cases revealed higher rates of gastroesophageal reflux than the cancer patients. Laryngopharyngeal reflux rates were slightly higher in laryngeal cancer patients than the controls in both upright (9.29% vs 7.67%, p: 0.6) and supine positions (4.83% vs 3.50%, p: 0.6). CONCLUSIONS: Laryngeal cancer patients and patients with heartburn complaints all have a high rate of gastroesophageal reflux. But cancer patients reveal a higher rate of laryngopharyngeal reflux than the symptomatic patients with normal laryngeal findings.

[Gastric pull-up in hypopharyngeal and cervical esophageal cancers]. / Hipofarenks ve servikal özofagus kanserlerinde gastrik pull-up.

OBJECTIVES: Gastric pull-up is a common technique in the reconstruction of gastrointestinal continuity following surgery for the primary esophageal and hypopharyngeal tumors with involvement of the esophagus. We evaluated the results of surgery in patients with cervical esophageal and hypopharyngeal cancers. PATIENTS AND METHODS: Eleven patients (4 women, 7 men; mean age 46 years; range 18 to 70 years) underwent surgery for hypopharyngeal and cervical esophageal epidermoid carcinoma. Surgery included pharyngolaryngoesophagectomy, subtotal thyroidectomy, and gastric pull-up in all patients. In addition, nine patients had radical neck dissection on the involved side and modified radical neck dissection on the contralateral side. One patient had bilateral radical neck dissection. Patients who were alive were followed-up for a mean period of 27 months (range 14 to 46 months). RESULTS: The one-, two-, and three-year survival rates were 54% (6/11), 36% (4/11) and 18% (2/11), respectively. Three patients died from early postoperative complications, two from organ failure due to locoregional recurrence (7th month) and to distant metastasis (11th month). CONCLUSION: Despite the small size of the study, the results favor the use of gastric pull-up in selected patients with cervical esophageal and hypopharyngeal cancers.