Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations.

OBJECTIVES: To evaluate endoscopic push-through technique cartilage myringoplasty results. METHODS: This prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies. RESULTS: Of 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences. CONCLUSION: Underlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.

Role of electrical stimulation added to conventional therapy in patients with idiopathic facial (Bell) palsy.

OBJECTIVE: The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic changes in patients with Bell palsy. DESIGN: This was a randomized controlled trial. Sixty patients diagnosed with Bell palsy (39 right sided, 21 left sided) were included in the study. Patients were randomly divided into two therapy groups. Group 1 received physical therapy applying hot pack, facial expression exercises, and massage to the facial muscles, whereas group 2 received electrical stimulation treatment in addition to the physical therapy, 5 days per week for a period of 3 wks. Patients were evaluated clinically and electrophysiologically before treatment (at the fourth week of the palsy) and again 3 mos later. Outcome measures included the House-Brackmann scale and Facial Disability Index scores, as well as facial nerve latencies and amplitudes of compound muscle action potentials derived from the frontalis and orbicularis oris muscles. RESULTS: Twenty-nine men (48.3%) and 31 women (51.7%) with Bell palsy were included in the study. In group 1, 16 (57.1%) patients had no axonal degeneration and 12 (42.9%) had axonal degeneration, compared with 17 (53.1%) and 15 (46.9%) patients in group 2, respectively. The baseline House-Brackmann and Facial Disability Index scores were similar between the groups. At 3 mos after onset, the Facial Disability Index scores were improved similarly in both groups. The classification of patients according to House-Brackmann scale revealed greater improvement in group 2 than in group 1. The mean motor nerve latencies and compound muscle action potential amplitudes of both facial muscles were statistically shorter in group 2, whereas only the mean motor latency of the frontalis muscle decreased in group 1. CONCLUSIONS: The addition of 3 wks of daily electrical stimulation shortly after facial palsy onset (4 wks), improved functional facial movements and electrophysiologic outcome measures at the 3-mo follow-up in patients with Bell palsy. Further research focused on determining the most effective dosage and length of intervention with electrical stimulation is warranted.

[Importance of laryngologic examination in chronic cough]. / Kronik öksürükte larengolojik muayenenin önemi.

OBJECTIVES: This study aims to investigate the distribution of etiologic factors related to otorhinolaryngology in chronic cough patients with normal lung examination and spirometric findings, and also highlight the importance of videolaryngostroboscopic (VLS) examination with these patients. PATIENTS AND METHODS: Seventy-six patients (31 males, 45 females; mean age 48.0±15.5 years; range 18 to 83 year) who applied to pulmonology outpatient clinic with cough complaint for more than two months were included in the study. After being evaluated by a pulmonologist, patients were referred to otolaryngology outpatient clinic. To detect the underlying cause of cough, patients' detailed histories, and flexible fiberoptic endoscopy and VLS findings were reviewed. Reflux symptom index (RSI) was used for the diagnosis of gastroesophageal reflux. RESULTS: In RSI ≥13 group, posterior commissure edema was detected in 12 patients (42.9%), and posterior commissure hyperemia was detected in four patients (14.3%). These findings were statistically significantly higher than RSI <13 group (p=0.006 and p=0.016, respectively). No significant difference was present between the group of patients with allergic rhinitis and the group of patients without allergic rhinitis in terms of VLS findings. Mucopurulent secretion rate in posterior commissure in patients with acute sinusitis findings was statistically higher than patients without acute sinusitis findings (p<0.001). CONCLUSION: Chronic cough is a common symptom of many different diseases. Therefore, a multidisciplinary approach is important for diagnosis. Videolaryngostroboscopy is a valuable examination tool in the differential diagnosis of gastroesophageal reflux and acute sinusitis.

The effects of nasal base stabilization techniques on nasal tip rigidity.

BACKGROUND: The aim of this study was to compare the degree of nasal tip rigidity from different techniques for increasing nasal tip projection. METHODS: Retrospective records of patients who had undergone rhinoplasty were reviewed at the tertiary referral center. 81 patients who had undergone suturing of the medial crura to the extension graft or to the long septum were selected. In group A, fixation was performed at the same level compared to before surgery. In group B, tip grafting was performed to gain 3 mm or more in projection after fixation as done in group A. In group C, the same tip projection was provided by advancing the medial crura on the caudal septum or extension graft. Patients were evaluated with a visual analog scale, based on the rigidity of the nasal tip (0=very flexible, 10=very rigid). RESULTS: When the preoperative and postoperative VAS scores of all groups were compared, postoperative scores were significantly higher than the preoperative scores (p<0.001). The postoperative scores of group C were higher than those of the other groups. These differences were statistically significant (p<0.001). There was no statistically significant difference between groups A and B with regard to the postoperative scores (p=0.389). However, in group C, the increase between preoperative and postoperative scores was significantly higher than in the other groups (p<0.001). CONCLUSION: Advancing the medial crura on the caudal septum and suturing to gain 3 mm or more of tip projection may result in a more rigid nasal tip. Patients should be informed preoperatively of this potential result. 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 .

Comparison of incus interpositioning technique versus glass ionomer cement application in type 2 tympanoplasty.

Objective of this study is to compare glass ionomer cement application and incus interpositioning techniques in patients who have chronic otitis media, conductive hearing loss with intact tympanic membrane and who undergo hearing reconstruction of staged surgery using a retrospective chart review in the setting of Ministry of Health Ankara Training and Research Hospital ENT Clinic, Turkey. We retrospectively evaluated patients who underwent otological surgery and hearing reconstruction with auto graft incus during 2005-2008 or glass ionomer cement during 2008-2010. Patients who had cholesteatoma, stapes fixation and tympanosclerosis were excluded. Postoperative mean follow-up time of 107 patients was 9.8 months (6-38 months, 83.2 % of them was ≤ 9 months). Postoperative pure tone hearing thresholds, graft status, gain scores and air bone gaps were recorded. Intact graft, dry ear on the operated side and ABG scores less than 20 dB were accepted as surgical success. Preoperative ABG score was 30.6 ± 7.93 dB in glass ionomer (group I) and 33.6 ± 11.99 dB in incus interpositioning (group II). Postoperative ABG scores were 13.6 ± 10.40 and 22.6 ± 12.39 dB, respectively, in group I and II. Success of closure in ABG scores was obtained in both groups (p < 0.001). Gain scores in group I were better (p = 0.035). Graft success (p = 0.020) correlated with gain score. Results showed that the glass ionomer cement application is a good, cost-effective technique, easy to perform and yields better hearing scores and lower complication rates compared to incus interpositioning technique.

Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss.

OBJECTIVE: To compare hearing results in idiopathic sudden hearing loss patients treated with systemic steroids alone or combined intratympanic and steroids. STUDY DESIGN: Prospective. SETTING: Tertiary referral hospital. PATIENTS: Idiopathic sudden sensorineural hearing loss patients. INTERVENTIONS: The patients in the systemic therapy group received consecutive administration of 100 mg intravenous methylprednisolone in the first day, 80 mg/day oral prednisolone in 3 divided doses for the next 2 days, and continued with oral administration of steroids by tapering the dose 20 mg in every 2 days. The patients in the combined treatment group received intratympanic injection of methylprednisolone (an approximate dose of 0.5 ml of 125 mg/ml). A total of 5 injections on alternate days were performed. MAIN OUTCOME MEASURES: The mean and median PTA gains of systemic corticosteroid therapy (SCT) group were 7.5 and 5 dB at 5th day, 12.1 and 7.5 dB at 10th day, and 13.0 and 8.8 dB at 15th day. The mean and median PTA gains for combined treatment (CT) group were 12.5 and 7.5, 17.8 and 13.8, 21.8 and 20.0 dB, respectively. RESULTS: Both the mean and the median PTA gains were statistically significantly different between SCT and CT groups. According to improved hearing results (more than 10 dB gain), there was statistically significant difference between SCT and CT groups. None of the patients had an important complication. CONCLUSION: The results of this study suggest that adding intratympanic methylprednisolone to systemic therapy increases the probability of hearing recovery in ISSHL patients.

Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index.

PURPOSE: The aims of this study were to investigate the prognostic impact of middle ear risk index on the postoperative hearing results in cases with type 2 ossiculoplasty; to compare the middle ear risk index results among primary, staged, and revision cases; and to compare the results of the prostheses used in ossicular reconstruction. MATERIAL AND METHODS: Records of 293 patients who had canal wall up tympanomasteidectomy and type 2 ossiculoplasty due to chronic otitis media between November 1995 and November 2007 were reviewed retrospectively. RESULTS: The mean preoperative air-bone gap was 32.6 dB, and it decreased to 15.2 dB after a mean follow-up period of 26.8 months postoperatively. The mean change of air-bone gap was 17.4 dB. Postoperative air-bone gap was 20 dB or less in 79% of the cases. The patients with dry perforations were in the low-risk group, and 91% of them had an air-bone gap of 20 dB or less. This value was 86% in the ones with intact malleus. The patients who had primary surgery were found in moderate risk group, whereas staged and revision groups were in the high-risk group. The air-bone gap was 20 dB or less in 84%, 78%, and 59%, respectively, of those groups. The difference between the primary and the revision groups reached a statistical significance. CONCLUSIONS: We had the best ossicular reconstruction results with glass ionomer cement, whereas the worst results were obtained with allograft partial ossicular replacement prostheses. We determined that risk-reducing factors such as dry ear, minimal ossicular chain defect, and intact malleus were important to have successful results. The middle ear risk index is a valuable tool for the surgeon to judge the risks and the probability success of the procedure as well as to make a good patient selection.

The impact of fixated glass ionomer cement and springy cortical bone incudostapedial joint reconstruction on hearing results.

CONCLUSIONS: Although it abolishes the incudostapedial joint, use of glass ionomer cement to repair the defect between the stapes head and the long process of the incus is a successful procedure when the hearing results are considered. OBJECTIVES: To compare the hearing results obtained by a fixed, stiff reconstruction with glass ionomer cement, and a flexible, springy pseudo-joint built with autologous cortical bone in patients with a small defect between the long process of the incus and the stapes head. PATIENTS AND METHODS: A total of 66 patients who had canal wall up tympanomastoidectomy due to chronic otitis media and incus long process defect between January 1996 and February 2008 were analyzed retrospectively. Their incudostapedial joints were reconstructed using either glass ionomer cement (n=31) or autologous cortical bone (n=35). RESULTS: The mean follow-up period was 22.8 months for all cases. The mean postoperative air bone gap (ABG) was 29.2 dB and it reduced to 11.8 dB at the end of the follow-up period. Preoperative and postoperative ABGs were 27.4 dB and 10.6 dB in the glass ionomer cement group and 30.9 dB and 12.8 dB in the cortical bone group, respectively. The ABG closure was 16.8 dB in the glass ionomer cement group and 18 dB in the cortical bone group.

The functional and anatomical results of the canal wall down tympanoplasty in extensive cholesteatoma.

CONCLUSION: Although we have shown that malleus handle and mucosal factors were important prognostic factors for hearing, we were unable to show the positive effect of the stapes superstructure on hearing results. The positive effect of the presence of the stapes superstructure on hearing results is closely related to the quality of the mucosa. OBJECTIVE: The aim of this study was to investigate the impact of ossicular and mucosal factors on hearing in primary canal wall down (CWD) surgery with ossicular chain reconstruction (OCR) performed for extensive acquired cholesteatoma. PATIENTS AND METHODS: A total of 134 adults who had CWD surgery with OCR for extensive acquired cholesteatoma between January 1996 and May 2007 were retrospectively analyzed. RESULTS: The graft insufficiency was 13%, chronic infection without cholesteatoma was 6% and cholesteatoma recurrence was 8% after the first operations. The rate of anatomic failure was 10% after a follow-up period of 46.3 months. In this study, we present the anatomic results for 136 ears and functional results for 135 ears. The hearing gain was significantly higher in the cholesteatoma-only group when compared with the mucosal-cholesteatoma disease group. Forty-three ears (54%) in the cholesteatoma-only group and 23 ears (42%) in the mucosal-cholesteatoma disease group had postoperative ABG within 20 dB. The best hearing results were obtained in Austin group B, while the worst hearing results were evident in Austin group C (p=0.017). Postoperative ABG was within 20 dB in 44% (n=31) of the patients with an intact stapes superstructure, while this ratio was 54% (n=35) when the stapes superstructure was absent.

[Epidural abscess and encephalocele following tegmen defect due to mastoidectomy: a case report]. / Mastoidektomiye bagli tegmen defekti sonrasi gelisen epidural apse ve ensefalosel: Olgu sunumu.

In chronic otitis media surgery, especially in cases with cholesteatoma, different complications can occur in the course of the operation or postoperatively. In our clinic, in one of the cases who had staged canal-wall down operation for otitis media with cholesteatoma, an iatrogenic 0.5x0.5 cm dural plate defect had occurred in tegmen tympani during the operation. In this article, we present an uncommon case who had encephalocele with epidural abscess because of unrepaired dural plate defect superimposed with early postoperative infection at the first month after the operation and we discuss it in the light of the literature.

First-choice treatment in mild to moderate obstructive sleep apnea: single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction or nasal continuous positive airway pressure.

OBJECTIVE: To compare the efficacy of single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) for the soft palate and base of the tongue with that of nasal continuous positive airway pressure (CPAP) in primary treatment of mild to moderate obstructive sleep apnea. DESIGN: A prospective nonrandomized clinical study. SETTING: Tertiary care referral center. PATIENTS: Data from 47 patients with mild to moderate obstructive sleep apnea treated between January 1, 2003, and October 31, 2006, were reviewed. INTERVENTIONS: Twenty-six patients underwent TCRFTVR and 21 underwent nasal CPAP as a primary treatment modality. MAIN OUTCOME MEASURES: Baseline and 12-month posttreatment measurements using the Epworth Sleepiness Scale and polysomnography were compared. RESULTS: The baseline characteristics of the groups were not significantly different. Both methods showed meaningful results for the Epworth Sleepiness Scale and polysomnography variables 12 months after treatment compared with baseline measurements. The results were not significantly different in the posttreatment intergroup comparisons. Treatment success rates were 52.4% for nasal CPAP and 53.8% for TCRFTVR (P = .92). CONCLUSION: Similar comparison results with nasal CPAP in objective and subjective variables make single-stage, multilevel TCRFTVR a good alternative in primary treatment of mild to moderate obstructive sleep apnea.

Determination of Helicobacter pylori in patients with chronic nonspecific pharyngitis.

OBJECTIVES/HYPOTHESIS: To determine if there is a relationship between Helicobacter pylori colonization in the pharynx mucous membrane and chronic nonspecific pharyngitis. STUDY DESIGN: A prospective clinical study. METHODS: Seventy patients with chronic pharyngitis and 20 healthy control subjects were examined with polymerase chain reaction (PCR) and culture for H. pylori colonization in the pharynx mucous membrane between March 2008 and October 2008. Patients with pharyngitis were seperated into two groups (35 patients in each) by using C-14 urea breath test, according to the presence of gastric H. pylori infection. RESULTS: In the control group, none of the patients had H. pylori in the pharynx. In the chronic pharyngitis group, in 12 patients (34.3%) with gastric H. pylori infection and in seven patients (20%) without gastric infection, H. pylori colonization in pharynx mucosa was determined with the PCR method. In only two of chronic pharyngitis patients (5.8%), H. pylori infection was detected with culture. In the pharynx mucosa, the H. pylori infection rate was significantly higher in the chronic pharyngitis groups than in the control group (P = .002 between C-14 positive and control groups, P = .040 between C-14 negative and control groups). There was not a significant difference in H. pylori colonization in the pharynx of patients who had chronic pharyngitis with or without gastric ailments and H. pylori infection (P = .179). CONCLUSIONS: Chronic nonspecific pharyngitis without gastric H. pylori infection is significantly related to H. pylori colonization in the pharynx, and gastric involvement increases the rate of this spread. The gold standart for detection of H. pylori infection is the PCR method.

The preventive effect of ginkgo biloba extract in myringosclerosis: study in rats.

OBJECTIVE: To determine the preventive effect of Ginkgo biloba extract in the formation of myringosclerosis. STUDY DESIGN: Prospective, randomized clinical study. MATERIALS AND METHODS: Posterosuperior quadrant of tympanic membranes of twenty-five Wistar Albino rats were bilaterally myringotomized. They were divided into three groups randomly. Groups 1 and 2 were administered 100 mg/kg/day and 200 mg/kg/day systemic Ginkgo biloba extract. The third group was treated with 1 mL/day saline solution. After 10 days of treatment, myringotomized membranes were examined by otomicroscopy and harvested. They were evaluated histopathologically by light microscopy and compared according to the occurrence of myringosclerotic plaques and the thickness of membranes. RESULTS: Tympanic membranes of groups 1 and 2 nearly had no existence of myringosclerosis (72.2% in group 1 and 83.3% in group 2, P = 0.434). However, in group 3, only 14.3 percent had no myringosclerosis (P < 0.001). Thickness of membranes in group 1 was 0.13 +/- 0.25, group 2 was 0.06 +/- 0.02, and group 3 was 0.19 +/- 0.35 mm. Group 3 had significantly thicker membranes compared with groups 1 and 2 (P < 0.001 for group 2 and P = 0.003 for group 1). CONCLUSION: Formation of experimental myringosclerosis was reduced or inhibited and tympanic membranes were thinner after systemic Ginkgo biloba extract administration.

Ossiculoplasty with intact stapes: analysis of hearing results according to the middle ear risk index.

CONCLUSIONS: In ossiculoplasty with intact stapes, using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses, improvement in hearing was nearly equal. In patients who had mild risk scores, the incus had better gain values compared with patients who had severe scores. OBJECTIVE: We aimed to prove the utility of the middle ear risk index score and its predictive value in hearing outcome. We also evaluated hearing results for different reconstruction materials. PATIENTS AND METHODS: This was a retrospective chart review of 189 patients who had ossiculoplasty with intact stapes using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses. Hearing outcomes and the average improvement in hearing with different reconstruction materials were analysed by using middle ear risk index scores. RESULTS: The average hearing improvements for incus, cortex and partial ossicular reconstruction prostheses were 12.77±14.58 (p<0.001), 12.34±15.98 (p=0.005) and 14.10±13.87 dB (p<0.001), respectively. The postoperative air-bone gap levels were 20.42±14.54 dB in incus, 17.33±16.86 dB in cortex and 17.59±11.66 dB in partial ossicular reconstruction prostheses. When the preoperative middle ear risk index scores and postoperative air-bone gap and gain values were compared, in the incus group, statistically significant associations were demonstrated between scores and hearing outcomes (p=0.009).

Ginkgo biloba, a free oxygen radical scavenger, affects inflammatory mediators to diminish the occurrence of experimental myringosclerosis.

CONCLUSION: Systemic Ginkgo biloba extract treatment reduces the levels of nitrite/nitrate, malondialdehyde, and superoxide dismutase and increases the levels of glutathione peroxidase. By scavenging free oxygen radicals, ginkgo extract prevents the formation of myringosclerosis. OBJECTIVE: Our objective was to evaluate inflammatory mediators to determine the antioxidant and anti-inflammatory effect of Ginkgo biloba extract to diminish myringosclerosis. MATERIALS AND METHODS: Thirty Wistar Albino rats, weighing 320-400 g were used. The upper posterior quadrants of both tympanic membranes were myringotomized and divided into four groups. Ginkgo biloba extract was given orally to groups 1 and 2 comprising eight rats with doses of 100 mg/kg/day and 200 mg/kg/day, respectively. Seven rats in group 3 received 1.5 ml/day saline and seven rats were left untreated. After 10 days of treatment, otomicroscopic evaluation of tympanic membranes and measurement of anti-inflammatory mediators such as superoxide dismutase, nitrite/nitrate, glutathione peroxidase and malondialdehyde were performed. RESULTS: Myringosclerosis was significantly more severe in control and saline groups than in Ginkgo biloba groups. The levels of nitrite in ginkgo-treated groups were significantly lower than in untreated and saline-treated groups, while glutathione peroxidase levels were significantly higher. The levels of malondialdehyde and superoxide dismutase were lower in ginkgo groups but not significantly.

The effect of stapes mobility on hearing outcome and which procedure to choose in fixed stapes in children tympanosclerosis.

OBJECTIVES: Our objective was to evaluate the features of tympanosclerosis in children and to determine the effect of stapes mobility and the type of one-stage operation on hearing outcomes. MATERIALS AND METHODS: Fifty-one children who were performed different types of single-stage otologic surgery for tympanosclerosis between January 1997 and December 2006 were retrospectively chart reviewed. The children were divided into two groups according to the mobility of ossicular chain, especially the stapes. Stapes fixed group was also evaluated in detail according to the type of surgery that was performed. Patients who had previous ventilation tube insertion, tympanic membrane parasynthesis or any other otologic surgery were excluded from the study. Improvement of the hearing by at least 10 dB and air-bone gap less than 20 dB were accepted as success criteria after 24 months of follow-up period. RESULTS: The air conduction levels, and the air-bone gap values of both groups were improved significantly after the single-stage operations. Pure tone averages pre- and postoperatively for stapes mobile group were 45.55+/-15.96 and 34.50+/-16.64 dB (p=0.002); and in stapes fixed group these were respectively 43.97+/-13.45 and 33.16+/-12.14 dB (p<0.001). When pre- and postoperative air-bone gap levels were evaluated it was seen that in both groups they were improved more than 10 dB, from 34.10+/-11.37 to 23.05+/-12.32 dB (p=0.002) in stapes mobile group and from 35.29+/-11.65 to 24.48+/-12.50 dB (p<0.001) in stapes fixed group. In stapes fixed group air-bone gap was less than 20 dB in 11 of 23 (47.8%) patients who had mobilization and 3 of 8 (37.5%) patients who had small fenestra stapedotomy operations. Although it was not statistically significant, gain was more than 10 dB only in 2 of 8 (25.0%) patients in the stapedotomy group but 14 of 23 (60.9%) patients in mobilization group (p=0.698 for ABG and p=0.220 for gain). The change in the bone conduction levels were improved 0.75 dB in group 1 and got worse 0.52 dB in group 2 and this was not statistically significant (p=0.239). CONCLUSIONS: In this study about children, the status of stapes and the place of tympanosclerotic mass had no significant negative effect on hearing improvement. You can perform mobilization in one-stage if you are experienced and have to prefer second-stage surgery if stapes is fixed and stapedectomy is needed.

Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy.

OBJECTIVES: To compare the efficacy of submucosal temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) and resection with microdebrider (SMRM) in chronic inferior turbinate hypertrophy. STUDY DESIGN: Prospective, randomized, and single-blinded clinical trial. METHODS: The study group consisted of 30 symptomatic patients who underwent simultaneous TCRFTVR and SMRM for consecutive sides. Visual analogue scale (VAS) and acoustic rhinometry (ARM) were made preoperatively and at 12th week and 6th month postoperatively; saccharine transport time (STT) and ciliary beat frequency (CBF) were performed at 12th week and 6th month postoperatively. The rate of the need for the revision operation was determined between 6 and 12 months period postoperatively. RESULTS: Significant improvement was achieved in VAS scores and ARM measurements after both procedures, whereas both parameters did not differ significantly between two procedures postoperatively. STT and CBF showed no significant post-treatment variation in comparison of the intergroup measurements. The rates of the need for revision operation were not significantly different. CONCLUSION: Identical results in objective and subjective parameters were observed for both techniques.

Intratympanic methylprednisolone for sudden sensorineural hearing loss.

OBJECTIVE: Corticosteroids are commonly used for the treatment of sudden sensorineural hearing loss (SSHL). In this study, the effectiveness of intratympanic (IT) corticosteroid injection was studied and compared with a control group on patients with SSHL who failed systemic corticosteroid treatment. MATERIALS AND METHODS: A total of 19 patients as a retreatment group (RG) and 18 patients as a control group (CG), all failed high-dose intravenous and oral corticosteroid treatments, were included in this study. These patients were invited back, and IT methylprednisolone was injected five times via 3-day intervals in RG and followed-up for a mean period of 24.9 months (range, 7-30 mo). Audiological evaluations were performed initially, a week after the completion of the injections, monthly in the following first 3 months, and at the end of follow-up period in RG. The CG was followed-up for 3 months after the completion of systemic corticosteroid treatment without any additional drug administration. RESULTS: The mean age was 52.6 years (range, 20-79 yr) in RG and 59.9 years in CG. The mean pure-tone average for speech frequencies (500-4,000 Hz) at baseline audiogram and at the first month, at the third month, and at last controls were 65.2 (range, 43-102 dB), 45.4 (range, 23-77 dB), 43.6 (range, 30-77 dB), and 44.5 (range, 33-77 dB) dB, respectively, in RG. The mean pure-tone averages for speech frequencies (500-4,000 Hz) at the end of systemic treatment and at third-month control were 63.5 (range, 44-98 dB) and 59.0 (range, 40-100 dB) dB, respectively, in CG. The hearing gain that is equal to or more than 10 dB was achieved in 14 patients (73.6%) at the last control in RG. No hearing gain could be detected in the CG. No serious side effect was observed with IT treatment. CONCLUSION: We conclude that IT methylprednisolone injection provides more significant hearing improvement for patients that failed with previous high-dose systemic corticosteroid administration than systemic corticosteroid treatment alone. So it may be the first-step medical treatment of idiopathic SSHL alone or at least may be combined with the systemic corticosteroid administration.

Bilateral congenital choanal atresia in a 7-day-old patient: transnasal endoscopic repair with stent.

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This paper is a case report of a 7-day-old full term girl infant presenting the history of attacks of cyanosis and having difficulty in suckling and respiration. On examination, alternating cyanosis and normal colour was observed in the patient. The application of nelaton cannulas bilaterally revealed the diagnosis of bilateral CCA. Transnasal endoscopic repair with stents was performed. Symptomatic resolution persists 6 months postoperatively.

Success is a matter of experience: type 1 tympanoplasty : influencing factors on type 1 tympanoplasty.

Our objective was to identify the factors that could influence the success rate of type 1 tympanoplasty in a tertiary care centre where both residents and senior surgeons perform this operation. Six hundred and seven patients who had been performed type 1 tympanoplasty as a primary otologic surgery between January 1997 and December 2004 were retrospectively chart reviewed. The patients had intact and mobile ossicular chain peroperatively. Patients with any other macroscopic otologic pathology like cholesteatoma, granulation in the middle ear and osteitis in mastoid cells were excluded from the study. Dry ear, intact and mobile tympanic membrane, improvement of the hearing by at least 10 dB and air-bone gap less than 25 dB were accepted as success criteria after 12 months of follow-up period. Chi-square test was used for statistical comparison of the different influencing factors. The male gender, younger age, smaller-sized perforations and experience of the surgeon were stated as good prognostic factors due to statistical evaluation. Afterwards the data of the study group was reanalysed in order to decide the cases for the residents. Finally, it was observed that seniors had better results in cases with perforations greater than 50%, dry ears and patients older than 16 years. In training and research clinics where both residents and senior surgeons perform type 1 tympanoplasty, the rate of success can be enhanced if patients with perforations greater than 50%, dry ears and patients older than 16 years are operated by the senior surgeons. The reason for this is that these groups have the overall worse results and should by argument be done by senior surgeons.