Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients / Efeitos da turbinoplastia versus fratura lateral e cauterização bipolar no volume da concha inferior hipertrófica compensatória em pacientes submetidos a septoplastia

Abstract Introduction: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

Resumo Introdução: A causa mais comum de falha da septoplastia é a hipertrofia das conchas inferiores não tratada adequadamente. Diversas técnicas foram descritas até o momento: turbinectomia total ou parcial, ressecção da submucosa (cirúrgica ou com microdebridador) e a fratura lateral. Objetivo: Neste estudo, comparamos os volumes pré e pós-operatório da concha inferior com hipertrofia compensatória com o uso de tomografia computadorizada entre pacientes submetidos a septoplastia e turbinoplastia ou fratura lateral com cauterização bipolar. Método: Este estudo retrospectivo incluiu 66 pacientes (37 homens e 29 mulheres) internados em nosso serviço de otorrinolaringologia entre 2010 e 2017 por obstrução nasal e submetidos à cirurgia por desvio de septo nasal. Os pacientes submetidos à turbinoplastia devido à hiperplasia compensatória da concha inferior formaram o grupo turbinoplastia; aqueles submetidos à fratura lateral e cauterização bipolar foram separados, formaram o grupo fratura lateral. Os volumes compensatórios da concha inferior de todos os pacientes que participaram do estudo (idade média de 34,0 ± 12,4 anos, faixa de 17 a 61 anos) foram avaliados por tomografia computadorizada dos seios paranasais nos planos axial e coronal no pré-operatório e aos dois meses do pós-operatório. Resultados: As dimensões transversais e longitudinais do grupo turbinoplastia no pós-operatório foram significantemente menores do que as do grupo de fratura lateral (p = 0,004). Em ambos os grupos, os volumes da concha inferior diminuíram significantemente (p = 0,002, p < 0,001, respectivamente). O volume pós-operatório da concha do lado do desvio aumentou significantemente no grupo turbinoplastia (p = 0,033). Conclusão: Tanto a turbinoplastia como a fratura lateral são técnicas efetivas de redução de volume. No entanto, a turbinoplastia causa maior redução do volume da concha inferior do que a fratura lateral com cauterização bipolar.

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients.

INTRODUCTION: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. OBJECTIVE: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. METHODS: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0±12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. RESULTS: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p=0.004). In both groups the lower turbinate volumes were significantly decreased (p=0.002, p<0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p=0.033). CONCLUSION: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

Assessment of Synaptic Plasticity via Long-Term Potentiation in Young Mice on the Day after Acoustic Trauma: Implications for Tinnitus.

OBJECTIVE: This experimental study evaluated the pathophysiological association of long-term potentiation (LTP)-mediated synaptic plasticity in tinnitus in 30 BALB/c mice. MATERIALS AND METHODS: Baseline hearing levels and tinnitus perception were examined with startle reflex time and gap detection time measurements using an acoustic stimulus of a 6-kHz pure tone at 90 dB sound pressure level (SPL) on post-natal day 16. The acoustic trauma group was exposed to 6-kHz pure tone at 120 dB SPL on post-natal day 16. On post-natal day 17, the acoustic trauma group underwent re-measurements of hearing levels and tinnitus perception using an acoustic stimulus of 6-kHz pure tone at 100 dB SPL. Fifteen tinnitus-induced and fifteen control subjects were sacrificed on post-natal day 17, and LTP in the dorsal cochlear nuclei of each animal was examined. RESULTS: With respect to gap detection time, there were no statistically significant between-group differences; however, there was a statistically significant difference between the pre- and post-trauma period in the acoustic trauma group. Moreover, LTP was significantly higher in the acoustic trauma group than in the control group. CONCLUSION: The results suggest that LTP underlies tinnitus pathogenesis.

Prognostic value of serum anti-heat-shock protein 70 and paraoxonase levels in idiopathic sudden sensorineural hearing loss.

OBJECTIVES: This study aims to investigate the correlation between serum anti-heat-shock protein 70 (anti-HSP 70) levels, serum paraoxonase (PON) levels and prognosis of idiopathic sudden sensorineural hearing loss (ISSHL). PATIENTS AND METHODS: Twenty-five patients with ISSHL as the study group and 25 healthy volunteers as the control group were enrolled in this study. Blood samples were obtained from all patients before the treatment initiation and on the 10th day of the treatment from only patients of the study group. Idiopathic sudden sensorineural hearing loss was defined as the hearing loss between 250-6.000 Hz frequencies. The recoveries in the hearing thresholds were evaluated at 10 days of the treatment. RESULTS: When the pre-treatment serum PON, anti-HSP 70 levels and the post-treatment serum PON, anti-HSP 70 levels of the patients with ISSHL were compared, we observed that the post-treatment serum PON levels of the recovered patients increased, while the post-treatment serum anti-HSP 70 levels of recovered patients decreased. CONCLUSION: We believe that serum levels of anti-HSP 70 and PON can be used as markers for estimating and evaluating the prognosis of ISSHL patients.

The effect of BMP-2, BMP-4 and BMP-6 on bone destruction of cholesteatoma presence.

OBJECTIVE: The aim of our study was to investigate the relationship between the destruction of temporal bone structures, ossicular chain destruction, dissemination of cholesteatoma and the expressions of bone morphogenetic proteins (BMPs), BMP-2, BMP-4 and BMP-6 in patients with acquired cholesteatoma. MATERIAL AND METHODS: This study was performed in a total of 80 patients with cholesteatoma and without cholesteatoma who had undergone surgery due to chronic otitis media. The patients were grouped as the study and the control groups. The study group comprised patients with primary acquired cholesteatoma, and the control group consisted of chronic otitis media patients without cholesteatoma. The samples were obtained from cholesteatoma tissue and the external acoustic meatus skin in study group patients and they were obtained from the external acoustic meatus skin only in control group patients. The Reverse Transcriptase Polymerase Chain Reaction method was used for the measurements of BMPs, BMP-2, BMP-4 and BMP-6 expressions. Polymerase Chain Reaction was studied by isolation of Ribonucleic Acid from the tissue samples. RESULTS: When the expressions of BMP in the external acoustic meatus skin were compared between the study and the control groups, the BMPs, BMP-2 and BMP-6 were determined to have a statistically significant relation in the study group (p<0.05), but BMP-4 was not significant (p>0.05). When the expression of BMP in cholesteatoma tissue was investigated in the study group patients, the BMPs, BMP-2 and BMP-6 were determined with statistically significant positivity (p<0.05), but there was no significant positivity for BMP-4 (p>0.05). In the study group, there was no statistical significance between the expressions of BMPs, BMP-2, BMP-4 and BMP-6 in cholesteatoma tissue, in the external acoustic meatus skin, and temporal and ossicular chain destruction, and dissemination of cholesteatoma (p>0.05). A statistically significant positivity for BMPs expression in cholesteatoma tissue was determined in patients with destruction of the incus+malleus+stapes (p<0.05). CONCLUSION: The expressions of BMPs, BMP-2 and BMP-6, were elevated in cholesteatoma tissue. Furthermore, the positivity of BMPs expression was statistically significant in patients with destruction of all the ossicles, and we think that this marker can be used for evaluation of the aggressiveness of cholesteatoma.

Prenatally exposure to exogenous glucocorticoids and stress may affect the inner ear.

OBJECTIVES: This study aims to investigate the effect of exogenous glucocorticoid exposure in the prenatal period on hearing and to evaluate the effectiveness of caffeic acid phenethyl ester (CAPE), an antioxidant, on the prevention of the inner ear injury. MATERIALS AND METHODS: Dexamethasone was given to half of twelve Sprague-Dawley pregnant rats and the distilled water was given to the remaining half. The real subjects were obtained by born of the offsprings. When the all subjects were two months of age, they were exposed to 110 dB noise during four hours as a stressor effect. These subjects were divided into three groups. Group 1: subjects to whose mothers were given distilled water; Group 2: subjects to whose mothers were given dexamethasone; Group 3: subjects to whose mothers were given dexamethasone and CAPE. RESULTS: While there was no statistical significance in hearing thresholds which exposed and not exposed to exogenous dexamethasone before noise exposure (p>0.05) between the groups, the elevation of hearing thresholds of subjects which exposed to exogenous dexamethasone was statistically significant after noise exposure (p<0.05). CONCLUSION: Prenatally exposure to exogenous glucocorticoids may cause the inner ear susceptible to the effect of noise, and CAPE is effective to prevent the possible damage.

Comparison of the histologic changes in conchae induced by radiofrequency thermal ablation and submucosal diathermy.

Objective of study was to determine the histological change induced in the conchae by submucosal diathermy and radiofrequency thermal ablation, two techniques used in the treatment of lower conchal hypertrophy, and to compare the two methods to each other. The study was performed on 15 rabbits. Radiofrequency was applied to the study animals in Group I (n = 5) and submucosal diathermy to Group II (n = 5), while Group III (n = 5) was the untreated control. The animals were decapitated 21 days after treatment and their conchae nasales ventrales excised on both sides. Histology slides were prepared and evaluated by light microscopy for ciliary loss, increase in submucosal vascularity, loss of goblet cells, inflammatory cellular infiltration, fibrosis and epithelial damage. The differences between Groups I and III were not significant regarding ciliary loss, increase in submucosal vascularity, loss of goblet cells and epithelial damage (p > 0.05), while the inflammatory cellular infiltration and fibrosis were significantly different between these groups (p < 0.05). As for the differences between Groups II and III, they were significant for each of the compared parameters (p < 0.05), while among Groups I and II they were significant for ciliary loss (p < 0.05), increase in submucosal vascularity, loss of goblet cells, inflammatory cellular infiltration and epithelial damage but not fibrosis (p > 0.05). Based on these findings, we can state that the use of radiofrequency thermal ablation causes less change in the normal conchal histology than submucosal diathermy application.

The relationship between Th1/Th2 balance and 1α,25-dihydroxyvitamin D3 in patients with nasal polyposis.

We aimed to study Th1/Th2 cell balance by measuring the levels of cytokines IL-4, IL-10, and IFN-γ, which play an important role in the immune response of patients with allergic rhinitis and/or nasal polyps, and determine the correlation between Th1/Th2 cell balance and 1α,25-dihydroxyvitamin D(3), an active metabolite of vitamin D. The study subjects were 60 adult patients and 40 healthy volunteers. Subjects were separated into three groups: 30 patients diagnosed with nasal polyposis together with allergic rhinitis formed Group I, 30 patients with nasal polyposis but without allergic rhinitis constituted Group II, and 40 healthy volunteers without nasal polyp and/or allergic rhinitis were the control group, or Group III. IFN-γ, IL-4, IL-10, and total IgE levels were determined in the serum samples of all patients and vitamin D(3) in their plasma. A statistically significant difference was found between the Group I and the control group in their IgE, IL-4, IL-10, IFN-γ, and vitamin D levels (p < 0.05), while there were no such significant differences between Group II and the control group in these measurements (p > 0.05). Within Group I, vitamin D levels showed a negative correlation with IgE and IL-4 levels, and a positive correlation with IFN-γ (p < 0.05). Within Group II, IgE levels showed a positive correlation with IL-4 and IL-10 levels (p < 0.05) and a negative correlation with IFN-γ levels (p < 0.05). In this study, no significant relation was detected between vitamin D deficiency and nasal polyposis in the absence of allergic rhinitis. The study demonstrates that vitamin D is effective on Th1/Th2 balance in patients with allergic rhinitis and that there is a significant relation between vitamin D deficiency and allergy. These results are compatible with the possibility of an important role of vitamin D in the pathogenesis and degree of severity of allergic disease, and its capacity to control allergic disease.

Presence of herpesviruses in adenoid tissues of children with adenoid hypertrophy and chronic adenoiditis.

OBJECTIVES: The aim of study was to determine the presence of some of the herpesviruses including herpes simplex virus (HSV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) in adenoid tissues of children with adenoid hypertrophy (AH) and chronic adenoiditis (CA) and to investigate the potential role of the herpesviruses in patogenesis of AH and CA. PATIENTS AND METHODS: A total of 72 patients (41 boys, 31 girls; mean age 4 years and 2 months; range 2 to 9 years) who underwent adenoidectomy or adenotonsillectomy (with or without placement of a ventilation tube) in our clinic between October 2007 and May 2008, were included. The patients were divided into two groups, as AH group (n=42) and the CA group (n=30). Adenoid tissues collected from patients in both groups were analyzed by polymerase chain reaction (PCR) for the presence of HSV, EBV and CMV-DNA. RESULTS: The results of the PCR indicated that 33.3% in the AH group and 36.6% in the CA group were herpesvirus DNA positive. Among the herpesviruses studied, HSV-DNA was detected at the highest level (14.2% and 16.6%, respectively) in both groups, although the difference between the groups was not significant. EBV-DNA positiveness was 11.9% and CMV-DNA was 4.7% in the AH group, whereas, EBV-DNA positiveness was 13.3% and CMV-DNA was 6.6% in the CA group. CONCLUSION: Herpesviruses were determined at a high rate in adenoid tissue of children with AH and CA, suggesting that there may be a potential relationship between the presence of herpesviruses and occurrence of AH and CA in children. However, more extensive studies are required to elucidate the role of herpesviruses in the pathogenesis of AH or CA.

Efficacy of glial growth factor and nerve growth factor on the recovery of traumatic facial paralysis.

The aim of this study was to assess the effects of Glial growth factor (GGF) and nerve growth factor (NGF) on nerve regeneration in facial nerve anastomosis. In this study, approximately a 1-mm segment was resected from the facial nerve and the free ends were anastomosed. All animals underwent the same surgical procedure and 30 rabbits were grouped randomly in three groups. Control group, the group without any medications; NGF group, the group receiving 250 ng/0.1 ml NGF in the epineurium at the site of anastomosis; GBF group, the group receiving 500 ng/0.1 ml GGF in the epineurium at the site of anastomosis. Medications were given at the time of surgery, and at 24 and 48 h postoperatively. After 2 months, the sites of anastomosis were excised and examined using the electron microscope. It was found that the best regeneration was in the group receiving GGF as compared to the control group in terms of nerve regeneration. Schwann cell and glial cell proliferation were found to be significantly higher in the group receiving GGF as compared to the group receiving NGF. Besides, the number of myelin debris, an indicator of degeneration, was significantly lower in the group with GGF as compared to NGF and control groups (p < 0.005). Using GGF and NGF in order to increase regeneration after nerve anastomosis in experimental traumatic facial nerve paralysis may be a hopeful alternative treatment option in the future. However, further studies on human studies are required to support these results.

The effects of methylprednisolone and halofuginone on preventing esophageal and hypopharyngeal fibrosis in delivered radiotherapy.

In this study, we assessed the effects of halofuginone and methylprednisolone on hypopharyngeal and esophageal stricture that can develop following radiation to the head and neck of rats. Rats were divided into four groups randomly and 18 Gy radiation was given to the head and neck regions of all rats except the control group. Group 1 (Control Group): No radiation or drugs were administered. Group 2 (Radiation Group): only radiation was applied without any drugs. Group 3 (Halofuginone Group): halofuginone 100 microg/kg per day was given intraperitoneally. Group 4 (Methylprednisolone Group): methylprednisolone 1 mg/kg per day was administered intramuscularly. In all groups, 90 days after application of radiation, sections of the proximal esophagus and hypopharynx were examined for fibrosis, fibroblast proliferation, vascularization, epithelial atypia, necrosis, polymorphonuclear leukocytes, mononuclear cells, and stenosis index by light microscope and the hydroxyproline levels were assessed biochemically. Fibrosis, epithelial atypia and hydroxyproline levels were found to be significantly higher in the radiation group compared to the control group (P < 0.05). We did not observe fibrosis in either the halofuginone or the control groups. Fibrosis was also significantly lower in the methylprednisolone group than the radiation group (P < 0.05). The differences of the stenosis index scores between the groups were not statistically significant (P < 0.05). Vascularization was similar in all groups. We think that especially halofuginone is a drug that can be used safely to prevent fibrosis due to radiotherapy, but further studies are needed.

The evaluation of vestibular functions in patients with pseudoexfoliation syndrome.

The main objective of the study is to evaluate vestibular system of the inner ear with postural tests in the patients with pseudoexfoliation syndrome (PEX). It is clinical case-control study. The study group included 34 patients with PEX and 40 controls without PEX. The patients and controls underwent complete ophthalmic and otorhinolaryngologic examinations. Vestibular functions were done by Fitzgerald and Dix-Hallpike, caloric tests, Romberg test, tandem Gait test, Quiks test in both control and study groups. Pur-tone and high-frequency audiography were also performed in all cases. The mean patient age was 63 years (+/-11.80) (range 47-74 years) in the PEX group and 65 years (+/-8.70) (range 61-68 years) in the control group with no differences among the two groups (P > 0.05). Although none of the 34 patients with PEX had clinical history of balance disturbance, 21 (61.76%) had significant pathologic sign in vestibular function tests (P < or = 0.05), while only 3 (7.5%) of 40 cases in the control group had pathologic sign in vestibular function tests. The scales from pure tone and high-frequency audiogram in the PEX group were similar to those of the control group. In conclusion, the patients with PEX, there may be a vestibular involvement in the pathological level in the inner ear. Larger clinical studies, experimental animal studies, and post mortem studies in humans are needed to disclose the pathology in the vestibulocochlear system in the patients with PEX.

Evaluation of the polymorphism in the Toll-like receptor 4 (TLR4) genes of tympanosclerosis patients.

OBJECTIVE: Although eardrum perforations which endure etiopathogenesis for a long-time and middle ear infections are proposed for causing the tympanosclerosis (TS), tympanosclerosis emerges in some chronic otitis media (COM), some of them do not appear although a continuing COM and enduring perforation last. In this study, the effect of the molecular reasons which display genetic differences in TS formation is evaluated; our aim is to determine the Asp299Gly polymorphism frequencies in the TLR4 gene of patients with TS who have COM, and patients who do not. MATERIALS AND METHODS: Patients who have undergone COM surgery, were divided into two groups of 50 persons who were selected in accordance with the fact, whether they had TS in their middle ear cavity or not during operation. 100 healthy persons who had similar demographic data, were evaluated as the control group. The DNA isolation was executed by using standard methods with peripheric blood specimen of the diseased group and control group. The Restriction Fragment Length Polymorphism method was used in determining the Asp299Gly allel in the TLR4 gene. Items of 249 bc for the wild tip (Asp) post-restriction enzyme segment wild tip (Asp) allel, and 23 bc and 196 bc post-restriction enzyme segment polymorphic allel (Gly) were obtained. RESULTS: TLR4 Asp299Gly polymorphism (10%) was asserted in a total of five specimens in the diseased group with TS. TLR4 Asp299Gly polymorphism was found positive in only one (2%) of the 50 phenomenons in the group without TS. TLR4 Asp299Gly polymorphism was found positive in six (6%) of the 100 phenomenons in the control group. The positive polymorphism in phenomenons with TS was significant in accordance with statistics, when compared with the group without TS (p<0.05). However, although the polymorphism rates were higher than the rates of the control group, it was not statistically significant (p>0.05). CONCLUSION: TS may not appear in many patients who had undergone middle ear infection, and had perforation for many years. The polymorphism in arteriosclerosis in the TLR4 gene which caused the inflammatory cytokines oscillation recognize the bacterial LPS, was also accused. It is engrossing to find out from the results of our study on a restricted number of patients, and on only one gene, that molecular reasons which display genetic differences can also be effective in forming TS. Serial researches of greater dimensions are required.

Combined laryngocele: a cause of stridor and cervical swelling.

A laryngocele is usually a cystic dilatation of the laryngeal saccule. The etiology behind its occurrence is still unclear, but congenital and acquired factors have been implicated in its development. In this study, we present a rare case of laryngocele occurring in a 72-year-old woman. During physical examination the external component of the laryngocele was seen as a swelling in the neck. The swelling became larger during Valsalva maneuver. On the endoscopic examination of the larynx, she had a bulging near the ventricular fold and the right aryepiglottic fold. Diagnosis of laryngocele was made and confirmed with physical examination, indirect laryngoscopy and magnetic resonance imaging (MRI).

The effect of topical ciprofloxacin and steroid-containing ear drops for chronic suppurative otitis media on the internal ear.

Aim of the study is to evaluate the effects of topical ciprofloxacin and prednisolone-containing ear drops for chronic suppurative otitis media on hearing threshold, cochlear reserve and cochlea morphology in healthy subjects and to determine the proper drug dose. Sixty-eight guinea pigs, all of which had healthy hearing, were used for the study. The first group (n = 30) was administered ciprofloxacin three times a day, the second group (n = 30) was administered prednisolone three times a day and the third group (n = 8) was administered sterile distilled water three times a day. The therapies lasted for 7 days and were administered intratympanically. The first group and second group were divided into three sub-groups of ten subjects. The first sub-group (n = 10) was administered an equivalent dose per kilogram as in humans, the second sub-group (n = 10) was administered one-third of the human-equivalent dose and the third sub-group (n = 10) was administered tenfold the human-equivalent dose. All subjects underwent brainstem evoked response audiometry (BERA) and distortion product otoacoustic emission (DPOAE) testing on the seventh and twenty-first days following the therapy. Following the tests, two subjects from each group were decapitated and examined under electron microscope. BERA and DPOAE testing results of the sub-group (n = 10) which was administered tenfold the human-equivalent dose were significantly different from the control group and other groups (P < 0.05). According to electron microscopic examination of the cochlea, the group which was administered a tenfold human-equivalent dose of intratympanic ciprofloxacin and prednisolone showed atrophy in cells and degenerations in cilia. This case was statistically significant when compared with the control group and other groups (P < 0.05). Ciprofloxacin and prednisolone applied at a human-equivalent dose per kilogram did not affect the hearing and cochlear histology of subjects.

Histopathologic and functional effects of facial nerve following electrical stimulation.

The aim of the study is to investigate the functional and histopathologic changes in facial nerve due to the application of various violent and numerous electrical stimuli to the facial nerve. The study was carried out with Wistar rats weighing between 200 and 300 g. The facial nerves of the subjects were located and stimulated with electrical stimulator. Then five groups were created with 18 subjects in each group: Group 1, 1 milliampere (mA) electrical stimulus applied; Group 2, 2 mA electrical stimulus applied; Group 3, 3 mA electrical stimulus applied; Group 4, 4 mA electrical stimulus applied; Group 5, 5 mA electrical stimulus applied. All groups were divided into three sub-groups, each consisting of six subjects. The facial nerves of the subjects in first sub-group were stimulated 10 times, in second sub-group were stimulated 20 times and those in third sub-group were stimulated 30 times. The functions of the facial nerves were evaluated on first day, first week and first month, respectively. The facial nerves with branches were dissected from the surrounding tissues carefully. These specimens were investigated by light microscope about axonal degeneration, macrovacuolization and vascular congestion. Loss of facial functions was not observed in the subjects during follow-up process. There was no significant difference between groups regarding axonal degeneration, macrovacuolization and vascular congestion (P > 0.05). While less axonal degeneration was observed in group which was stimulated 10 times, more axonal degeneration was observed in groups which were stimulated 20 and 30 times (P < 0.05). The axonal degeneration, macrovacuolization and vascular congestion were observed more in 1-day groups (P < 0.05). Consequently, lesser violence and lesser number of electrical stimulus application to the facial nerve appears to be an important criterion for not damaging the facial nerve in patients in whom stimulators have been used.

Evaluation of long-term impacts of tonsillectomy on immune functions of children: a follow-up study.

OBJECTIVE: The purpose of this follow-up study was to investigate the long-term effects of tonsillectomy in comparison with their short-term results. PATIENTS AND METHODS: We successfully retrieved 20 out of our previously reported 37 patients who underwent tonsillectomy in our clinic 54 months ago. The blood levels of CD3+, CD4+, CD8+, CD19+, CD25+ and CD16++56+ (cellular immunity), and IgG, IgA, IgM, C3 and C4 (humoral immunity) were determined and compared with their previously reported short-term respective values. RESULTS: There were no statistically significant differences between the short-term (1 month) and long-term (54 months) values of IgA, IgG, IgM and C4 levels of the patients (P>0.05). There was a slight but statistically significant decrease in complement factor C3 value compared to its the early-stage value (P<0.05) but this was not significantly different from age-matched healthy controls (P>0.05). The levels of CD4+ and CD19+ were higher and the levels of CD16++56+ and CD25+ were lower in the late-stage (54 months) compared to their early-stage values (P<0.05). When the long-term immune parameters of the tonsillectomized patients were compared with aged-match healthy controls, there were no significant differences between the levels of immunoglobulins, complements and lymphocytes (IgA, IgG, IgM, C3, C4, CD3+, CD4+, CD8+, CD19+, CD25+, CD16++56+) (P>0.05). CONCLUSION: The results of this long-term follow-up study indicate that tonsillectomy do not compromise the immune functions of children as humoral and cellular immunity of patients recovered compared to their early-stage immune status (1 month), as they have similar immune capacity compared to their age-matched healthy controls at both early- and late-stages. Although a small sample of patients enrolled, our results are of importance with respect to the reassuring in settling the widely held urban myth that tonsillectomy compromises life long immunity.

Histopathologic changes in guinea pig mastoid mucosa after topical mitomycin C application followed by mastoidectomy.

PURPOSE: This study was performed to investigate the histopathologic changes observed in mastoid cavity of guinea pigs after the application of mitomycin C after mastoidectomy. MATERIALS AND METHODS: The study was performed on 50 guinea pigs. Unilateral (right ear) mastoidectomy was performed on all guinea pigs. Twenty-five guinea pigs were separated as study group and the remaining were separated as control group. A mitomycin C-soaked sponge was placed in the mastoid cavities of the study group and a dry sponge was placed in those of the control group. Their mastoid cavities were examined histopathologically for absorbable sponge waste, abscess formation, fibrosis, vascularization, polymorphonuclear leukocyte infiltration, edema, lymphoplasmacytic inflammatory infiltration, and granulation tissue. RESULTS: Absorbable sponge waste, abscess formation, fibrosis, vascularization, edema, and lymphoplasmacytic inflammatory infiltration were not significantly different between the groups. However, polymorphonuclear leukocyte infiltration and granulation tissue were statistically different between the groups. CONCLUSION: Mitomycin C can be used after mastoidectomy to decrease the granulation tissue formation in ear discharges and to prevent the discharge.