Ultrasonic identification of internal jugular vein fenestration.

OBJECTIVE: Anatomic variations have curicial importance during neck surgery. We present a fenestrated internal jugular vein variation and the accessory nerve passing through it. Also, we discuss preoperative diagnosis of this variation using ultrasonography. METHOD: The possible recognition of this variation by ultrasonography is introduced. RESULTS: The accessory nerve in an internal jugular vein fenestration can be seen using ultrasonography. CONCLUSION: Preoperative identification of this rare variation may secure surgeon from potential complications.

Vit D deficiency is a possible risk factor in ARS.

Vitamin D deficiency is effective in the development of acute rhinosinusitis and prolongation of inflammation by increasing inflammation in the sinonasal epithelium. Vitamin D deficiency is important in the development of bone barriers that prevent the complication of acute rhinosinusitis. Although Vitamin D levels may be a variable risk factor for various respiratory tract disorders, there are limited data on the role in sinonasal infections. Our aim was to investigate the association of 25-hydroxy-vitamin D (25OHD) levels with acute rhinosinusitis (ARS) and preseptal cellulitis complications. The type of the study is prospective case-control study. Fifteen patients in the pediatric age group with ARS-induced preseptal cellulitis complication were identified as Group 1, fifteen patients with ARS and without complication were identified as Group 2, and fifteen healthy volunteers were identified as Group 3. Serum 25OHD levels (nmol/l) were measured in addition to routine blood tests at the first admission of patients participating in the study. Statistical analysis was performed between groups. The ages of the cases ranged from 1 to 14 years with a mean of 5.62 ± 3.42 years. 55.6% of the cases (n = 25) were male; 44.4% (n = 20) were female children. As a result of classification in which vitamin D levels were compared with normal values, there was a statistically significant difference according to the presence of ARS (Group-1 and Group 2) and absence of ARS (Group-3) (p < 0.05). A statistically significant difference was also found between Group 1 and Group-3 (p < 0.05). Statistically significant difference between Group 1 and Group 3 suggests that lack of vitamin D predisposes to the complication of preseptal cellulitis. Comparison of Group 1 and 2 with Group 3 (normal subjects) suggests that Vit D has a protective effect against developing sinusitis.

Carotid Artery Aneurysm: A Rare Cause of Hemotympanum.

Temporal bone fractures can occur as a result of various head trauma. The most common cause of the hemotympanum is traumatic temporal bone fracture. Facial paralysis and hearing loss can be seen associated with temporal bone fracture. The development of the internal carotid artery aneurysm after temporal bone fracture is extremely rare. In this article, the authors evaluated carotid artery aneurysm that developed after temporal fracture and aneurism compressed by coagulated blood mass which showed itself as a hemotympanum. The internal carotid artery aneurysm that induced by temporal bone fracture and presented as hemotympanum has not been reported yet. This patient is the first case in the literature. Diagnosis, treatment, and follow-up options will be discussed in the light of current literature.

The Effect of the Angle and Length of the Eustachian Tube on the Success Rate of Cartilage Type 1 Tympanoplasty.

OBJECTIVES: To explore the relationships between the angle and length of the eustachian tube (ET) (the ETa and the ETl) and the success rates of type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 160 patients (81 females and 79 males; average age, 37.12 ±â€Š12.46 years; age range: 18-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. A P value <0.05 was considered to reflect statistical significance. RESULTS: In group A, the ETa of diseased ears was 27.74 ±â€Š12.06° in males and 21.87 ±â€Š7.58° in females. In group A, the ETa of normal ears was 27.53 ±â€Š4.15° in males and 22.25 ±â€Š4.67° in females. In group B, the ETa of diseased ears was 28.85 ±â€Š6.19° in males and 22.91 ±â€Š5.65° in females. In group B, the ETa of normal ears was 27.71 ±â€Š5.23° in males and 23.72 ±â€Š6.20° in females. In group A, the mean ETl of diseased ears was 42.1 mm (28.9-45.1) in males and 38.2 mm (31.0-44.7) in females. In group A, the mean ETl of normal ears was 41.9 mm (29.2-45.8) in males and 37.4 mm (30.5-44.1) in females. In group B, the mean ETl of diseased ears was 40.8 mm (30.2-47.4) in males and 37.9 mm (31.8-45.2) in females. In group B, the mean ETl of normal ears was 41.6 mm (30.0-45.0) in males and 39.1 mm (30.0-43.7) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears the ETa was higher in males than females (P =0.002 and P <0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P >0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P >0.05). CONCLUSION: Neither the ETa nor the ETl affected the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of type 1 tympanoplasty.

Vidian Canal Types and Dehiscence of the Bony Roof of the Canal: An Anatomical Study.

OBJECTIVE: To determine the prevalence of Vidian canal types and dehiscence of the bony roof of the canal. METHODS: This study included 594 patients (391 males and 203 females; average age, 32.43±11.98 years; range, 18-65 years). Computed tomography (CT) images were analyzed in terms of the prevalence of Vidian canal types and dehiscence of the bony roof of the canal. RESULTS: Vidian canal types 1, 2, and 3 based on the sphenoid sinus body were found on the right side in 33.8%, 29.7%, and 6.5%, and on the left side in 36.4%, 27.4%, and 36.2% of the patients, respectively. Dehiscence of the bony roof of the canal was found on the right side in 22.2% of the patients and on the left side in 26.6%. In terms of Vidian canal types based on the sphenoid sinus floor, types 1, 2, 3, and 4 were found on the right side in 53.5%, 27.4%, 7.6%, and 11.5%, and on the left side in 54.9%, 26.6%, 6.6%, and 11.9% of the patients, respectively. On the right side, Vidian canal type 2 was significantly (p=0.002) more frequent in males than in females. CONCLUSION: When studying the complex anatomy of the sphenoid sinus, it is essential to consider Vidian canal types. Before endoscopic sinus surgery the Vidian canal and other anatomical structures should be carefully evaluated in all patients during preoperative paranasal sinus CT imaging to avoid complications.

Correlation Between the Degree of the Mastoid Pneumatization and the Angle and the Length of the Eustachian Tube.

OBJECTIVES: The aim of the present study is to explore the correlation between the degree of the mastoid pneumatization and the angle (ETa) and the length of the Eustachian tube (ETl). STUDY DESIGN: The study design consisted of a retrospective clinical chart review. METHODS: In total, 217 patients (110 females and 107 males; average age, 33.14 ±â€Š12.88 years; age range: 18-65 years) were included in the study. The patients were divided into 3 groups in terms of the degree of the mastoid pneumatization. The mastoid pneumatization was measured between 0 and 5 cm for group A, between 5 and 10 cm for group B, and ≥10 cm for group C. The ETa and ETl of each group were compared. RESULTS: The mean mastoid pneumatization of groups A, B, and C was 4.32 ±â€Š1.96, 8.26 ±â€Š2.68, and 11.94 ±â€Š1.28 cm, respectively. The ETl of group A was lower than that of other groups statistically (P = 0.006 and 0.018, respectively). The mean ETl did not differ between the groups B and C (P = 0.698, >0.05, respectively). The ETa of each group did not differ (all P > 0.05). The mastoid pneumatization and the ETl were higher in males than in females (P = 0.004 and 0.001, respectively). The ETa did not differ between males and females (P = 0.0158). There was a positive correlation between the degree of the mastoid pneumatization and the ETl (r = 0.159/P = 0.002, <0.05, respectively). CONCLUSIONS: The present study is thus the first to analyze the relationship between the degree of the mastoid pneumatization and the ETa and the ETl. We found a positive correlation between the degree of the mastoid pneumatization and the ETl.

Impact of the Degree of the Mastoid Pneumatization on Cartilage Type 1 Tympanoplasty Success.

OBJECTIVES: To evaluate the effect of the degree of the mastoid pneumatization on the success rate of cartilage type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 90 patients (44 females and 46 males; average age, 38.40 ±â€Š11.12 years; age range: 21-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The mastoid air cell volumes of each groups were compared. RESULTS: The mean mastoid pneumatization in groups A and B was 5.32 ±â€Š1.96  and 5.06 ±â€Š2.12 cm, respectively. The mastoid pneumatization of diseased ears did not differ between the groups (P > 0.05). The mastoid pneumatization of diseased ears did not differ between males and females (P > 0.05). The mastoid pneumatization of normal ears did not differ between the groups (P > 0.05). The mastoid pneumatization of normal ears did not differ between males and females (P > 0.05). CONCLUSIONS: The degree of mastoid pneumatization did not affect the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to evaluate the relationship between the degree of the mastoid pneumatization and anatomical outcomes after placement of various graft types.

Assessment of Effects of Septoplasty on Acoustic Parameters of Voice: A Prospective Clinical Study.

OBJECTIVE: To investigate the effects of septoplasty on the acoustic parameters of voice. METHODS: In total, 23 patients (seven females and 16 males; average age, 32.13±9.67 years; age range: 19-56 years) with a diagnosis of nasal septal deviation and who underwent septoplasty were included. Preoperative and on postoperative 30th day, acoustic analysis of voice was conducted for all patients. The recordings of /mana/ vowel were used to evaluate average fundamental frequency (F0), jitter, shimmer, and noise-to-harmony ratio (NHR). F0, shimmer percent, jitter percent, and NHR of two terms were compared. A p-value<0.05 was considered to indicate statistical significance. RESULTS: A statistically significant change was not observed in F0 (p=0.741), jitter (p=0.930), and shimmer (p=0.128) measured preoperatively and on postoperative day 30. However, the increase in NHR measured on postoperative day 30 were statistically significant compared with preoperative NHR (p=0.017). CONCLUSION: According to the findings of this study, except NHR value, no statistically significant changes on F0, jitter and shimmer were detected after septoplasty.

Etiological classification of presbycusis in Turkish population according to audiogram configuration.

OBJECTIVES: This study aims to classify age related hearing loss in Turkish population according to Schuknecht audiometric configurations for presbycusis and investigate the most common etiologies. PATIENTS AND METHODS: A total of 1,134 patients (568 males, 566 females; mean age 70.5±7.7 years; range 55 to 80 years) with age related hearing loss were included in the study. Audiograms of patients were classified into three categories: high frequency steeply sloping (HFSS), flat, and high frequency gently sloping (HFGS). Speech discrimination scores were evaluated and compared. RESULTS: In the study population, HFSS audiogram configuration was the most frequently observed (48.5%), followed by HFGS configuration (26.9%), and flat configuration (24.5%), respectively. While HFSS audiogram configuration was statistically significantly more common in males, flat audiogram configuration was statistically significantly more common in females (p=0.0001). HFSS group mean air conduction threshold were statistically significantly higher than flat and HFGS groups (p=0.0001). No statistically significantly difference was detected in terms of speech discrimination scores between three groups (p=0.796). CONCLUSION: Results of this study suggest that, in Turkish population, while sensory presbycusis is more common in males, strial presbycusis is more common in females. No difference was detected in terms of the prevalence of cochlear presbycusis in males and females (p=0.0001).