Effect of preoperative mastoid ventilation on tympanoplasty success.

Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20-35.09% female and 37-64.91% male) with a mean age of 29.69 ± SD (range 12-56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05).

[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.

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.

Analysis of long-term hearing after tympanosclerosis with total/partial stapedectomy and prosthesis used.

CONCLUSION: Long-term hearing gain results are good after prosthetic reconstruction of the stapes in the tympanosclerotic ear. The type of stapedectomy, whether partial or total, does not affect the result of the surgery very much. OBJECTIVES: Comparative evaluation of the hearing results of total/partial stapedectomy technique and the prosthesis used within a 10-year follow-up period after stapedectomy in cases with dense tympanosclerosis and completely fixed stapes. PATIENTS AND METHODS: Twenty-five cases with completely fixed stapes due to generalized tympanosclerosis were included in this retrospective study between 1995 and 2005. Two-stage canal wall up procedure was planned for all cases, and stapedectomy was performed at the second stage. After the second stage, 25 ears in the sixth month, 18 ears in the first year, 14 ears in the second year, and 7 ears in the tenth year were available for follow-up. Preoperative and postoperative air-bone gap values of the patients and their hearing gain were compared. Total stapedectomy was carried out in 17 of the patients and partial stapedectomy in 8 of them. For ossiculoplasty, a plastipore total ossicular replacement prosthesis was used in 17 patients, homograft ossicle in 2 patients, and Teflon piston in 6 patients. RESULTS: In 17 cases in which we used total stapedectomy, the average preoperative air-bone gap value improved from 40.23 to 18.47 in the sixth month, and from 38.4 dB to 9.6 dB in the tenth year. In eight cases in which we used partial stapedectomy, the average preoperative air-bone gap improved from 38.63 dB to 24.38 dB and from 35 dB to 17 dB, respectively. The average postoperative hearing gain with total stapedectomy was 21.76 dB in the sixth month and 28.8 dB in the tenth year. Hearing gain with partial stapedectomy was successively 14.25 dB and 18 dB. When we compared the results of total prosthesis and Teflon pistons among the materials used in ossiculoplasty, although hearing gain with total prostheses was better, the results were not statistically significant.

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.

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.

Infected inferior turbinate pneumatization.

With the widespread utilization of endoscopic nasal surgery, the interest in nasal structures has increased. Inferior turbinate pneumatization is among the most rare causes of nasal obstruction. In the current literature, there are only ten reported cases of inferior turbinate pneumatization. A 52-year-old male patient presented with nasal obstruction, purulent nasal discharge, facial pain and headache. Anterior rhinoscopic examination showed bilateral middle and inferior turbinate hypertrophy and edema of the nasal mucosa. Computed tomography (CT) revealed bilateral frontal, anterior and posterior ethmoidal and maxillary sinusitis with bilateral concha media bullosa and right infected inferior turbinate pneumatization. In this report, infection of this rare anatomical abnormality is presented for the first time and documented with acoustic rhinometry, CT and peroperative photography.

Sudden hearing loss due to large vestibular aqueduct syndrome in a child: should exploratory tympanotomy be performed?

A 16-year-old girl applied to our ENT clinic with a 3-day history of right hearing loss, tinnitus, and pressure in the right ear. She had had surgery for right perilymph fistula two times, one at the age of 7 and the second at the age of 9. She had recovered after both of these surgeries. This time she had exploratory tympanotomy and perylymh fistula was detected. Computerized tomography investigation obtained after 5 days postoperatively showed bilateral large vestibular aqueducts and otherwise normal inner ear structures. Thyroid function tests and neck palpation were normal. It was an unusual case with both large vestibular aqueduct syndrome (LVAS) and simultaneous spontaneous perilymph fistula.

Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography?

OBJECTIVE: Evaluate palpation, ultrasonography (USG), and computed tomography (CT) with respect to their value for comparative determination of metastatic lymph nodes in head and neck cancer. STUDY DESIGN: A prospective study was conducted in a tertiary referral hospital. During September 1996 and April 1999, clinical investigation, USG, and CT were performed preoperatively on 48 patients who would undergo neck dissection for primary head and neck malignancy. The presence of metastatic lymph nodes in pathologic specimens were compared with the findings of palpation, CT, and USG. RESULTS: Twenty-two of the patients had positive lymph nodes on pathologic investigation. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for palpation are 64%, 85%, 74%, 78%, and 75% respectively. Respective values for USG and CT for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy are 72%, 96%, 80%, 94%, and 85% and 81%, 96%, 85%, 90%, and 87%. CONCLUSION: All of the pretreatment evaluation methods, palpation, CT, and USG yield results that are significantly different from the histopathologic results, suggesting that no pretreatment study can accurately assess the requirement to histopathologically stage the neck. USG findings are more correlated with the pathologic findings than palpation, but CT gives the most effective and reliable results when it is combined with USG in neck staging. Preoperative USG and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis, staging, and therapy choices. SIGNIFICANCE: Statistical analysis was done with chi(2) test. The difference between histologic findings and palpation is significant (P = 0.0005). The difference between histologic findings and USG and CT is significant (P = 0.0001 and P = 0.0001).

Surgical management of pediatric ranula.

OBJECTIVE: Many surgical techniques have been described in the literature and their recurrence rates have been compared. Few studies have compared the results of the most popular techniques such as excision and marsupialization in pediatric population. METHODS: Sixteen children were operated for ranula. Total excision with sublingual gland was performed on 10 patients while marsupialization was performed on 6 patients. These patients were followed up at least 3 years. Their charts were investigated retrospectively. RESULTS: The age range was between 17 days and 16 years old. The mean age was 9 years. There were 12 females and 4 males. One patient (6.25%) had recurrence after excision and marsupialization was performed on this patient. The recurrence rates for marsupialization and excision were 0 and 10%, respectively. Ranulas were ruptured during surgery in 11 cases (68.75%) while a defect on the floor of the mouth had occurred in 1 patient. Only one of the cases among ruptured cases (9%) had reoccurred. The most common complication was rupture of the ranula in 11 patients (68.75%) followed by a defect on the floor of the mouth in one case. CONCLUSION: Rupture of the cyst during surgery does not increase the risk of recurrence. Besides marsupialization or excision do not make any difference in terms of success of surgery.

Combined treatment of sudden sensorineural hearing loss with steroid, dextran and piracetam: experience with 68 cases.

The purpose of this study was to evaluate the effectiveness of our combined treatment regimen and to clarify the possible prognostic factors in sudden sensorineural hearing loss (SSNHL). In a retrospective chart review, the charts of 68 patients who matched the inclusion criteria of this study were evaluated. All patients were treated with a standard regimen including prednisone, dextran and piracetam between January 1998 and December 2001. Initial (at the beginning of therapy) and final (3 weeks after the beginning of therapy) audiograms were compared with respect to hearing improvement. Possible prognostic factors were also evaluated. Overall hearing improvement was determined as 54.4%. Sex was the only determined prognostic factor in this study. Females had a better prognosis. Our treatment regimen had no superiority to the reported spontaneous hearing recovery. Females seem to have a better prognosis.

Surgical treatment of cholesteatoma in children.

OBJECTIVES: To present our experience in the surgical treatment of cholesteatoma in children. STUDY DESIGN: Retrospective clinical trial. PATIENTS AND METHOD: Charts of 114 patients who met the inclusion criteria of the study were examined. Surgical results were compared with respect to applied surgical methods. Cholesteatoma recidivism (CR) and hearing improvement were the main parameters which were examined. RESULTS: The mean age was 13 years and mean follow-up period was 3.7 years. A total of 200 operations performed on 114 children: 114 children operated at the first stage, 84 children underwent a second surgery, and 2 a third surgery. At initial operation; canal wall-up (CWU) tympanomastoidectomy was the choice of surgical procedure in 35 (31%) patients, and canal wall-down (CWD) tympanomastoidectomy was preferred for the other 79 (69%) patients. At final analysis; 26 of 114 (23%) patients had CWU procedure, 67 patients (59%) had CWD procedure and 21 patients (18%) had radical mastoidectomy. (CR) rate was 26 and 16%, respectively for CWU and CWD procedures for initial surgeries (P = 0.248). Hearing improvement was achieved in 36% of CWU procedures and 38% of CWD procedures (P = 0.957). Hearing deterioration was observed in 36% of CWU procedures and 47% of CWD procedures (P = 0.328). CONCLUSION: There was no significant difference between CWU and CWD procedures with respect to CR, hearing improvement, and hearing deterioration. Therefore, choose of surgical procedure should be individualized for each patient. In our opinion; open techniques must be employed in the presence of extensive disease, whereas the closed technique is reserved for those with a more localized problem.

Effect of 23 valent pneumococcal polysaccharide and Haemophilus influenza conjugated vaccines on the clinical course of otitis media with effusion.

OBJECTIVE: To determine if there is any clinical effect of 23-valent pneumococcal and type B conjugate vaccine on prognosis of otitis media with effusion. METHOD: All children who have middle ear effusion despite long-standing antibiotherapy with a beta lactamase stable agent were offered for tympanostomy tube insertion between February 1999 and December 2001. Patients who accepted the surgical intervention were operated under general anesthesia and a Shepard grommet-type tympanostomy tube was inserted. Those who refused the surgical intervention were vaccinated with 23-valent pneumococcal and type B conjugate vaccine. State of the middle ear effusion was evaluated at the end of the 12th month in the vaccine group and 1 month after the myringotomy site was healed in the tympanostomy tube insertion group. RESULTS: Twenty-six children in the vaccine group and 37 children in the tympanostomy tube insertion group proved the inclusion criteria at the end of study. Complete or partial resolution of middle ear effusion was observed in 73.1% of 26 children in the vaccine group and 59.5% of children in the tympanostomy tube insertion group. There was no significant difference between the two groups. CONCLUSION: Vaccination against and type b seems to aid resolution of middle ear effusion in children with otitis media with effusion.