An important procedure in ossiculoplasty: autoclaving the ossicles.

Autoclaving of the ossicles prior to ossiculoplasty is a very important procedure in surgery of cholesteatomatous chronic otitis media. Autoclaving allows the reuse of the ossicles removed from patients with cholesteatomatous chronic otitis media as an autograft. It also allows utilization of the malleus, incus and stapes taken from cadavers or of the uneroded malleus and incus removed from patients undergoing non-functional middle ear surgery chosen carefully with detailed history and laboratory analysis. The powerful disinfecting effect of the sterilising procedures of the homografts inactivates prion proteins which cause degenerative encephalopathies. In various studies, it has been concluded that autoclaving does not alter the matrix of the bone which is responsiable for its biophysical properties, whereas it removes all viable cells within the bone and dentures the soft tissue attached to the surface of the ossicle. We have also found confirming histological results in our two previous studies published in 1999 and 2001. It is usually recommended that soft tissue on the surface of the ossicles is removed before autoclaving. It is also sufficient to autoclave the ossicles at 134 degrees C, and at 2.5 atmosphere pressure for 5 minutes in a flash autoclave. The autoclaving time of the homograft ossicles must be longer, for 20 minutes. Following the autoclaving, these homograft ossicles should be kept at pH 5.6 for 3 days, then use a solution of 0.5% formaldehyde at pH 7 and 4 degrees C for 21 days and it should be washed with physiologic saline solution three times for 7 minutes before use. Depending on the results obtained from our planned comparative experimental study, there will be no need for additional formaldehyde fixation procedure after autoclaving and the autoclaved ossicles will be used immediately without preservation in formaldehyde solution for 24 days.

Can homograft ossicles still be used in ossiculoplasty?

The use of ossicular homografts has been legally forbidden in many countries for the last five years. In Turkey, imported ossicular biomaterials are very expensive. Malleus and incus homografts were mostly obtained during non-functional ear microsurgery on selected patients using a detailed history and special preoperative tests to avoid the risk of virus contamination. In order to determine the method for the procedure, the ossicles were first investigated histologically. The histological studies have shown, that there are no differences in the organic osseus matrix, the collagen fibres and the lamellar structure formed by these fibres in all groups of ossicles. According to the classical method, we preferred autoclaving at 135 degrees C temperature for 20 minutes after immersing the ossicles in 4% formol solution at pH 5.6 for 3 days. These ossicles were kept in 0.5% formol solution at pH 7 refrigerated at 4 degrees C. Until 1995, allograft ossicles, treated with formaldehyde solution without sterilization in the autoclave were our choice. For the last 4 years, we have been using sterilization with the autoclave especially to inactivate the prions. If the ossicles of the patient are over-eroded, ossicular allografts, which can be obtained without any cost are still a choice of treatment in our country. In the surgery of cholesteatomacous chronic otitis media, the malleus and incus which were in contact with the cholesteatoma, could be used like an autograft in ossiculoplasties, after autoclaving.

[Hereditary deafness in Turkey. Initial results]. / Hereditäre Schwerhörigkeit in der Türkei. Erste Ergebnisse.

The authors describe a study in progress to identify Turkish families with hereditary hearing loss and isolate possible responsible disease genes. Due to extreme genetic heterogeneity and limited audiological differentiation of hereditary hearing loss, it is necessary to identify large or small families from genetic isolates to locate loci responsible for hearing loss on a chromosome. To accomplish this goal, the medical records of 3800 children were examined at the ENT Clinic of Ege University between 1975 and 1994. All were suspected of having various hearing impairments. Additionally, students from two schools for the hearing impaired in Izmir and Eskisehir, Turkey were examined. To date, 16 families with syndromal deafness and 55 families with non-syndromal hereditary hearing loss involving two or more affected individuals have been identified and categorized according to the mode of inheritance. The majority (66%) of the non-syndromal families showed an autosomal recessive pattern, 29% an autosomal dominant inheritance and 5% an X-linked mode of inheritance. In the study presented there has been a predominance of affected males versus females and the consanguinity rate was 22%.

A second middle eastern kindred with autosomal recessive non-syndromic hearing loss segregates DFNB9.

A second kindred has been identified which supports the previously reported location of DFNB9. Linkage has been established to markers closely linked to DFNB9 which is located on 2p22-p23. The hearing impaired individuals in this highly consanguineous kindred from Eastern Turkey have prelingual profound hearing loss which affects all frequencies. A genetic map of the 2p22-p23 region where DFNB9 resides was generated using marker genotypes available from the CEPH database. All markers were placed on this genetic map using a likelihood ratio criterion of 1000:1. This map suggests that the region for DFNB9 is less than 1.08 cM, 95% confidence interval (0-2.59 cM).

[A computer-assisted patient databank for the ENT field]. / Eine computergestützte Patientendatenbank für den HNO-Bereich.

In this study, a patient database program was prepared for patients admitted to the ENT Department of Ege University Hospital, Izmir. The algorithm of the program was created by using dBASE IV. In order to develop a patient database, a careful preparation and running stage had to be accomplished. However, the most important factor was proper maintenance. The greatest problem during the maintenance stage was compliance of the doctors or secretaries using the program. This was overcome by choosing or making a user-friendly, flexible, practical and beneficial patient database program. The study also showed that doctors could make their own patient databases and use them efficiently if they are interested in computers.

[Treatment of sudden deafness apropos of 447 cases]. / Traitement des surdités brusques: à propos de 447 cas.

Due to 447 cases of sudden deafness followed up and treated during the last ten years in their clinic, the authors report the results of their treatment method composed of normovolemic hemodilution followed by fractional perfusion of vasodilators, corticosteroids and anticoagulants. Presenting overall examination of this population with audiological, vestibular, clinical, hematological and radiological findings, they insist on the need for emergency treatment and discuss the different aspects of this problem. They also present a global evaluation of the investigations performed on some patient groups. The most spectacular recoveries are obtained in cases who present earlier and who have a hearing loss of low frequencies.

The evaluation of the changes of voice registers in trainee singers by using the two-channel signal processing method.

This study was done at the ENT Department of the Ege University Medical Faculty on twenty trainee singers. Using the two-channel signal processing method, the electroglottographic (EGG) signals and the voice signals were digitized with an analog-digital converting card during an ascending and descending glissando exercised by the trainee singer. These signals were recorded on the computer's hard disk and the obtained data was analysed. It has been determined that the EGG signals were more irregular the singing formant of the voice signal was very weak or absent and the change of register was more significant in less trained singers. This method can be used to evaluate objectively the change of voice registers in the training of the singers and be easily performed by adding an analog-digital converting card to a PC computer, without the need of expensive modern devices.

[Arytenoidopexy in bilateral abductor paralysis of the glottis]. / L'aryténoïdopexie dans la paralysie bilatérale des dilatateurs de la glotte.

The arytenoidopexy operation has been performed in 15 cases of bilateral abductor paralysis of different causes. A tube on n. 6 for women and a tube of n. 6.5 for men has been used for the intratracheal general anesthesia without a tracheotomy. The microdissection of the arytenoid has been realised under the operation microscope. The fixation suture of the arytenoid has been passed with a special needle set prepared by the experimental studies on the laryngectomised pieces. The functional respiration result has been controlled by the pre and postoperative spirometry. The laryngeal spasm disappeared and very good respiratory functional results have been obtained in all cases. After a post-operative phoniatric reeducation, the voice was found to be good in most of the cases.