Evaluation of inner ear damage by mastoid drilling with measurement of serum prestin (SLC26A5) levels.

OBJECTIVE: The objective of this study is to demonstrate any inner ear injury caused by drilling in mastoid surgery with prestin, outer hair cell motor protein specific to the cochlea. METHODS: The patients with chronic otitis media requiring mastoidectomy (n = 21) and myringoplasty (n = 21) were included. Serum prestin level obtained from blood samples was measured before surgery and on postoperative days 0, 3, and 7 using Human Prestin (SLC26A5) ELISA Kit. All patients underwent the Pure Tone Audiometry (PTA) test before surgery and on the postoperative 7th day. The drilling time was also recorded for all patients who underwent mastoidectomy. RESULTS: In both mastoidectomy and myringoplasty groups, the postoperative serum prestin levels increased on days 0 and 7 (pday-0 = 0.002, pday-7 = 0.001 and pday-0 = 0.005, pday-7 = 0.001, respectively). There was no significant difference in the serum prestin levels between the two groups, postoperatively. The PTA thresholds at day 7 did not change in either group. A significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. There was no correlation between the drilling time and the increase of prestin levels in the postoperative day 0, 3, and 7. CONCLUSION: Our results showed that mastoid drilling is not related to a significant inner ear injury. Although the myringoplasty group was not exposed to drill trauma, there was a similar increase in serum prestin levels as the mastoidectomy group. Also, a significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. These findings suggest that suction and ossicular manipulation trauma can lead to an increase in serum prestin levels and postoperative temporary or permanent SNHL at 2000 and 4000 Hz. LEVEL OF EVIDENCE: Level-4.

Bilateral Congenital Agenesis of Stapes and Oval Window in Two Members of a Family (Brother and Sister).

Congenital agenesis of the stapes and the oval window is rare. Congenital stapedial agenesis (CSA) may be recognized preoperatively in the presence of conductive hearing loss. The principal radiological imaging approach of the temporal bone, computed tomography (CT), can be used to diagnose CSA. Our 17-year-old male patient (case A) had long-term hearing loss which was getting worse. A temporal bone CT scan revealed the absence of the stapes and the oval window on both sides and an abnormal position of the facial nerve. No anomalies were detected in the external ear structures. Explorative right ear tympanotomy revealed an abnormal inferior course and dehiscence of the facial nerve. The oval window and stapedial structures were absent. Patients were evaluated for continued hearing aid use or bone-anchored hearing aid implantation. Similar CT imaging and clinical abnormalities were seen in his 16-year-old sister (case B). They did not have any other siblings and neither of their parents nor any of their relatives had hearing loss. This report presents the CT scans of the two siblings with mixed hearing loss (mainly conductive) and the perioperative image of the first case. A genetic study may help explain the etiopathogenesis since both cases had similar clinical and imaging findings.

The let-7 microRNA binding site variant in KRAS as a predictive biomarker for head and neck cancer patients with lymph node metastasis.

BACKGROUND: The let-7 family of microRNAs regulate multiple oncogenes including the KRAS gene and has been shown to play a critical role in carcinogenesis. In this study, we aimed to investigate polymorphic alterations of the let-7 miRNA binding site (rs61764370) in the 3'UTR region of the KRAS gene as a predictive biomarker for head and neck cancer (HNC) and to evaluate its association with clinicopathological parameters. MATERIAL AND METHODS: The frequency of the KRAS-LCS6 variant in 216 Turkish HNC' patients and 85 healthy individuals were evaluated. After extracting DNA from whole blood, the variant allele was analyzed by polymerase chain reaction and restriction fragment length polymorphism method. Genotype and allele frequencies were evaluated using the De-Finetti case-control program. RESULTS: 85.6 % of the patients were wild type, 13 % heterozygous and 1.4 % homozygous variant. Although the KRAS-LCS6 variant was not associated with the risk of HNC (p > 0.05), G homozygous variant allele was found to be significantly associated with HNC patients having lymph node metastasis [T vs G: OR(%95 CI)= 2.370 (1.03-5.41), p = 0.03, χ2 = 4.38]. It was found statistical significance between genotype frequencies and smoker patients [TT vs TG: OR(%95 CI)= 0.357 (0.13-0.97), p = 0.03, χ2 = 4.32] by using De-Finetti analysis. Statistical significance was observed between KRAS-LCS6 genotype frequencies and gender, smoking, alcohol, early/late-stage, lymph node metastasis according to univariate analysis and Cox proportional hazards regression model (p < 0.05). CONCLUSION: This is the first study to reveal the relationship between KRAS-LCS6 variant and lymph node metastasis in HNC. The LCS6 variant of the KRAS gene may be a candidate predictor risk biomarker for lymph node metastasis in HNC.

Anatomical landmarks for cochlear implantation in ossified cochleas.

PURPOSE: In this study, we aimed to introduce the facial nerve as a new anatomical landmark which can be used in ossified cochleas during cochlear implantation. We also set out to define a safe line to preserve the internal auditory canal (IAC) while drilling the basal turn of the cochlea. METHODS: Thirty patients who had temporal computed tomography (CT) were studied. The distances from the facial nerve and the round window to the IAC, carotid artery, and jugular bulb were measured in the reformatted CT images. We have created a line in the direction of the stapedial tendon from the round window to the IAC and called it ROWIAC (Round window-IAC) line. We have investigated whether this line intersects the IAC and measured the distances from this line to the IAC. RESULTS: Fifty-four temporal CT scans were included to the study. The mean distances from the facial nerve to the IAC, carotid artery, and jugular bulb were 8.8 ± 0.9, 15.0 ± 2.0, and 12.2 ± 2.9 mm, respectively. The mean distances from the round window to these structures were 3.8 ± 0.7, 9.4 ± 2.2, and 8.3 ± 2.9 mm, respectively. ROWIAC line did not intersect the IAC in any of the patients. The mean distance between this line and the IAC was 0.8 ± 0.4 mm. CONCLUSION: We propose that facial nerve and ROWIAC line can be used as potential landmarks during cochlear implantation in ossified cochleas to protect the adjacent neurovascular structures.

Otoprotection to Implanted Cochlea Exposed to Noise Trauma With Dexamethasone Eluting Electrode.

Cochlear implantation (CI) is now widely used to provide auditory rehabilitation to individuals having severe to profound sensorineural hearing loss (SNHL). However, CI can lead to electrode insertion trauma (EIT) that can cause damage to sensory cells in the inner ear resulting in loss of residual hearing. Even with soft surgical techniques where there is minimal macroscopic damage, we can still observe the generation of molecular events that may initiate programmed cell death via various mechanisms such as oxidative stress, the release of pro-inflammatory cytokines, and activation of the caspase pathway. In addition, individuals with CI may be exposed to noise trauma (NT) due to occupation and leisure activities that may affect their hearing ability. Recently, there has been an increased interest in the auditory community to determine the efficacy of drug-eluting electrodes for the protection of residual hearing. The objective of this study is to determine the effect of NT on implanted cochlea as well as the otoprotective efficacy of dexamethasone eluting electrode to implanted cochlea exposed to NT in a guinea pig model of CI. Animals were divided into five groups: EIT with dexamethasone eluting electrode exposed to NT; EIT exposed to NT; NT only; EIT only and naïve animals (control group). The hearing thresholds were determined by auditory brainstem recordings (ABRs). The cochlea was harvested and analyzed for transcript levels of inflammation, apoptosis and fibrosis genes. We observed that threshold shifts were significantly higher in EIT, NT or EIT + NT groups compared to naive animals at all the tested frequencies. The dexamethasone eluting electrode led to a significant decrease in hearing threshold shifts in implanted animals exposed to NT. Proapoptotic tumor necrosis factor-α [TNF-α, TNF-α receptor 1a (TNFαR1a)] and pro-fibrotic transforming growth factor ß1 (TGFß) genes were more than two-fold up-regulated following EIT and EIT + NT compared to the control group. The use of dexamethasone releasing electrode significantly decreased the transcript levels of pro-apoptotic and pro-fibrotic genes. The dexamethasone releasing electrode has shown promising results for hearing protection in implanted animals exposed to NT. The results of this study suggest that dexamethasone releasing electrode holds great potential in developing effective treatment modalities for NT in the implanted cochlea.

Three-Dimensional Reconstruction of the Semicircular Canals with a Two-Hands Model.

OBJECTIVE: To help understand the anatomy and the diseases of the semicircular canals (SCCs) by defining the three-dimensional reconstruction of the SCCs in a model reconstructed using the two hands (two-hands model) and to determine the three-dimensional configuration of the two hands by measuring the angle between the SCCs and the sagittal plane. METHODS: Patients older than 18 years of age with computed tomography (CT) scans of the temporal bones taken between 2017 and 2018 at the Yeditepe University Hospital were included in the study. CT images were evaluated by a radiologist. The angles between every SCC and the sagittal plane were measured with the MIMICS 12.1 program. Mean angles between the SCCs and the sagittal plane were measured. These angles were demonstrated on the two-hands model of the SCCs by means of a goniometer and photographed. RESULTS: Thirty patients and 60 temporal bones were included in the study. Mean angles between the superior, the posterior, and the horizontal SCCs and the sagittal plane were found as 37.1±3.3°, 50.4±4.1°, and 89.5±4.7°, respectively. CONCLUSION: This is the first study to define the three-dimensional representation of the SCCs with a two-hands model. This may allow for a better understanding and the better teaching of the anatomy and diseases of SCCs.

The Feasibility of Retrofacial Approach for Cochlear Implantation.

HYPOTHESIS: The retrofacial approach is a feasible approach to the round window niche and that the Round window-Sigmoid sinus line will help determine the feasibility of retrofacial approach for cochlear implantation unless there is a very high jugular bulb. BACKGROUND: When the round window cannot be visualized by facial recess approach during cochlear implantation, other conservative techniques can be used to improve visualization such as the retrofacial approach. METHODS: Thirteen adult dry cadaveric temporal bones were studied. Computed tomography (CT) scan was obtained on all temporal bones. An imaginary Round window-Sigmoid sinus line was drawn on the axial images. We assessed whether this line is anterior (including intersection) or posterior to the facial nerve (FN). The following closest distances were measured on CT scans: 1) posterior semicircular canal (PSC)-FN, 2) PSC-Stapedius muscle, 3) PSC-Jugular bulb, 4) lateral semicircular canal (LSC)-Jugular bulb, 5) sigmoid sinus-FN. A canal wall-up mastoidectomy, facial recess, and retrofacial approach were performed in all specimens. We have noted whether we need a standard or an extended mastoidectomy. RESULTS: The Round window-Sigmoid sinus line was posterior to the FN in all specimens. The retrofacial approach was feasible and the round window was visualized in all specimens. Extended mastoidectomy was required in seven specimens and the PSC-FN was ≤ 3 mm in five of them. CONCLUSION: Retrofacial approach is feasible in cochlear implantation when the Round window-Sigmoid sinus line is posterior to the FN and the jugular bulb is not obstructing the round window.

A new technique to find the facial nerve and recess by using the short process of the incus and the spine of Henle as landmarks: incus-spine angle.

BACKGROUND: Precise techniques to find the facial nerve (FN) and recess are lacking. OBJECTIVES: We aimed to define incus-spine and incus-FN angles which can be used to localize the FN and recess during mastoidectomy. MATERIAL AND METHODS: Thirty adult cadaveric temporal bones were studied. Canal-wall up mastoidectomy with a facial recess approach was performed. The temporal bones and microscope were positioned differently to change the visual angle. The following distances were measured: (1) Short process of the incus (SPI)-FN; (2) Body of the incus-FN. Photographs were taken. Three lines were drawn on the photographs between the SPI, FN, and the spine of Henle. The angles were created and measured. RESULTS: Three of the temporal bones were excluded due to the absence of the spine of Henle and two of them due to the displacement of the SPI. The mean of the incus-spine angle in 25 temporal bones was 90.12° and the mean of the Incus-FN angle was 135.96°. The mean distances of the SPI-FN and body of incus-FN were 4.85 and 9.26 mm, respectively. CONCLUSIONS AND SIGNIFICANCE: The incus-spine and the incus-FN angles along with the distances can help localize the FN and recess.

Novel pathogenic variants underlie SLC26A4-related hearing loss in a multiethnic cohort.

OBJECTIVES: The genetics of sensorineural hearing loss is characterized by a high degree of heterogeneity. Despite this heterogeneity, DNA variants found within SLC26A4 have been reported to be the second most common contributor after those of GJB2 in many populations. METHODS: Whole exome sequencing and/or Sanger sequencing of SLC26A4 in 117 individuals with sensorineural hearing loss with or without inner ear anomalies but not with goiter from Turkey, Iran, and Mexico were performed. RESULTS: We identified 27 unique SLC26A4 variants in 31 probands. The variants c.1673A > G (p.N558S), c.1708-1G > A, c.1952C > T (p.P651L), and c.2090-1G > A have not been previously reported. The p.N558S variant was detected in two unrelated Mexican families. CONCLUSION: A range of SLC26A4 variants without a common recurrent mutation underlies SLC26A4-related hearing loss in Turkey, Iran, and Mexico.

PlasmaBlade vs. cold dissection tonsillectomy: A prospective, randomized, double-blind, controlled study in adults.

We conducted a prospective, randomized, double-blind, controlled clinical study to compare the efficacy and safety of the PlasmaBlade device and cold dissection for adult tonsillectomy. Our study group was made up of 20 patients-12 men and 8 women, aged 18 to 50 years (mean: 27.1)-who were undergoing a bilateral tonsillectomy. Each patient had one randomly chosen tonsil removed by the PlasmaBlade and the other by cold instrumentation. We compared the duration of surgery, the amount of intraoperative blood loss, the number of sutures required, the status of tonsillar fossa wound healing at 7 and 14 days postoperatively, the amount of postoperative pain, and postoperative complications. We found statistically significant differences in the amount of blood loss and the number of sutures in favor of the PlasmaBlade technique. No significant differences were observed in any of the other outcomes.

Follow-Up Results of Newborns after Hearing Screening at a Training and Research Hospital in Turkey.

OBJECTIVE: This study aimed to present the follow-up results of newborns after universal newborn hearing screening at a Training and Research Hospital in Istanbul and to determine the ages of diagnosis, hearing aid fitting, and cochlear implantation in newborns with hearing loss. MATERIALS AND METHODS: A total of 5985 newborns were screened between December 2009 and August 2011 using the transient evoked otoacoustic emission test as the first two steps and automated auditory brainstem response (ABR) test as the third step. Newborns who failed the screening tests were referred to a tertiary hospital for clinic ABR and were followed up at least for 2 years. RESULTS: Of 5985 newborns, 5116 (85.5%) completed the screening. Of 53 newborns who were referred to a tertiary hospital, 13 (0.25%) had a hearing impairment. The mean age of diagnosis, hearing aid fitting, and cochlear implantation were 6.1, 9.5, and 24.5 months, respectively. Among the risk factors for hearing impairment, neonatal intensive care (60%) and consanguineous marriage (50%) were the most common ones that were encountered. CONCLUSION: Our results were consistent with the national literature. Consanguineous marriage may be a risk factor for hearing impairment where it is commonly practiced because consanguineous marriage is significantly high in parents of deaf children. The ages of diagnosis and hearing aid fitting are still beyond the recommended ages by the Joint Committee on Infant Hearing.

Is Metabolic Syndrome Associated with Obstructive Sleep Apnea in Obese Adolescents?

OBJECTIVE: To investigate whether there is an association between metabolic syndrome and obstructive sleep apnea syndrome (OSAS) in obese adolescents. METHODS: In total, 240 pubertal children or prepubertal children older than 11 y recruited consecutively from the pediatric endocrinology unit, obesity clinic. Patients with tonsillar and adenoid hypertrophy (grade 3/4), systemic illnesses, or chronic drug usage were excluded. After anthropometric measurement and laboratory study, patients were divided into two groups according to metabolic syndrome (MS): MS and non-MS. Overnight polysomnographic evaluation was performed and 104 subjects were included for statistical analysis. The two groups were compared in terms of sleep efficiency, number of awakenings per night, oxygen desaturation index, snoring time, and obstructive/central/ mixed apnea-hypopnea index (AHI). RESULTS: Of the obese adolescents, 51 had MS and 53 did not. The AHI was ≥ 1 in 25 of the 53 non-MS children (47.2%) and in 25 of the 51 MS children (49%). The median obstructive AHI value was 0.9 (0.2-2.4) and total AHI was 0.9 (0.2-2.5) in the MS group; these values were 0.9 (0.25-3.55) and 0.9 (0.3-3.55), respectively, in the non-MS group. Obstructive, central, mixed, and total AHI values in the MS and non-MS groups were not statistically significantly different (p > 0.05). CONCLUSIONS: In our study, we did not find an association between MS and sleep apnea in obese adolescents.

Detection of ideal reservoir level after laryngectomy using endoilluminator in voice rehabilitation.

OBJECTIVE: To assess the diagnostic value of a novel device, the endoilluminator, in patients who can or cannot attain effective speech after application of voice prosthesis. STUDY DESIGN: Prospective clinical study. METHODS: Thirty-four patients who underwent total laryngectomy and whose insufflation test was positive were included. As a result of efforts to develop an insufflation test that includes a light apparatus, we attained a device that we call an endoilluminator. We found that the area it illuminated when a patient achieved effective speech was a predictive factor for the test result. That is, patients for whom the upper part of the tracheostomy (where the standard tracheoesophageal fistula will be opened) was illuminated were categorized as the positive test group, whereas those for whom the neck skin above this region was illuminated were categorized as the negative test group. RESULTS: In 27 of the 34 patients, appropriate localization was determined using the endoilluminator, and these patients achieved effective speech. In the remaining seven patients, localization was inappropriate and they did not achieve effective speech during the first week, first month, or third month postpuncture. In further investigations of these seven patients, a pharyngoesophageal spasm was detected in five, and a pharyngoesophageal stricture was detected in two. CONCLUSION: Endoilluminator increases the success rate of the insufflation test by accurately predicting a patient's ability to achieve effective speech after application of voice prosthesis.

[A rare cause of oropharyngeal mass: bilateral aberrant internal carotid artery]. / Orofarenks kitlesinin nadir bir nedeni: Iki tarafli aberan internal karotis arter.

Bilateral pharyngeal internal carotid artery aberration is a rarely seen variation which poses a risk during the surgical interventions of this area. A 74-year-old male patient was admitted to our clinic with the complaints of a sensation of fullness in his throat and dysphagia. Oropharyngeal examination revealed bilateral smooth-surfaced masses in the posterior pharyngeal wall. Magnetic resonance imaging showed an aberrant internal carotid artery. The patient was followed up with necessary warnings. The pulsation on the pharyngeal masses should be definitely evaluated and aberrant internal carotid artery should be kept in mind, if present.

Cervical cystic vagal schwannoma mimicking a type 3 second branchial cleft cyst: a case report.

In this article, we report a rare case of a cervical cystic vagal schwannoma mimicking a type 3 second branchial cleft cyst clinically, radiologically and cytologically. Although schwannoma is rare, it should be considered in the differential diagnosis of cystic neck masses. This article suggests that Doppler ultrasonography, computed tomography and fine needle aspiration biopsy findings may not be sufficient to provide the correct preoperative diagnosis of cystic lateral neck masses and further imaging techniques may be required.

Radiation-induced osteosarcoma of the larynx: case report and literature review.

Laryngeal osteosarcoma is an extremely rare disease. Only 23 cases have been published in the literature. Radiation-induced laryngeal osteosarcoma is even rarer; this is only the third such case to be reported. A 59-year-old man underwent radiotherapy for an in situ laryngeal squamous cell carcinoma at another institution. Five years later he developed a laryngeal osteosarcoma, and a total laryngectomy was performed. Although previous reports showed a poor prognosis, our patient was without disease at the 8-year follow-up. To the best of our knowledge, this is the longest disease-free follow-up to be reported in the literature. We also present a review of the world's literature.

[Late neck metastasis in esthesioneuroblastoma: a case report]. / Estesyonöroblastomda geç boyun metastazi: Olgu sunumu.

Esthesioneuroblastoma is a rare malignancy of olfactory neuroepithelium arising from sinonasal region. It has biologically an aggressive behavior. The tumor is characterised by common local recurrence, atypic distant metastasis and poor long-term prognosis. Cervical metastasis accounts for 20-30% of the patients. Late metastases are seen particularly six months or later following primary treatment. In this article, we present a 43-year-old female case with Kadish B stage esthesioneuroblastoma who underwent extracranial tumor resection and postoperative radiotherapy. Eleven years later (at 132 months) right neck cervical metastasis was occurred and we applied right functional neck dissection and adjuvant radiotherapy to treat. We also review the treatment of late neck metastasis in the light of the current literature data.

A huge cemento-ossifying fibroma of paranasal sinus: a case report.

Cemento-ossifying fibroma is a well-bordered, slow-growing, benign fibro-osseous disease. Although its localization is generally in the mandible, it can be seen in any area of the craniofacial region. Radiology and histopathology help to diagnose the condition. Treatment is based on close observation and/or surgical excision. In this case, we report the case of a 62-year-old male patient who had a large radiological appearance, cemento-ossifying fibroma in the paranasal sinuses.