Transcanal Endoscopic Management of Middle Ear Paragangliomas.

OBJECTIVE: To evaluate the clinical and audiological outcomes of transcanal endoscopic resection of middle ear paragangliomas. STUDY DESIGN: Retrospective multicenter study. SETTING: Tertiary referral center and private otology clinic. PATIENTS: Patients who underwent transcanal endoscopic surgery between January 2015 and September 2020. INTERVENTIONS: Transcanal endocope-assisted resection of middle ear paragangliomas. MAIN OUTCOME MEASURES: Demographic data. RESULTS: Twenty-three patients (2 men, 21 women) with a mean (standard deviation [SD]) age of 50.5 (11.8) years and stage 1 or 2 disease were included in the study. The mean follow-up time was 2.7 years (range, 1-5 yr). Preoperatively, the mean (SD) air-conduction threshold was 33.8 (17.9) dB, and the mean (SD) air-bone gap was 13.1 (13.9) dB. Postoperatively, the mean (SD) air-conduction threshold was 25.7 (10.2) dB, the mean (SD) air-bone gap was 6.3 (6.1) dB. The mean (SD) hospital stay was 27.7 (9.9) hours. No tumor regrowth was detected on magnetic resonance imaging during postoperative follow-up. CONCLUSIONS: Endoscopic transcanal tumor resection is effective and feasible in the treatment of stage 1 and 2 tumors and is associated with short operative time, low risk of perioperative and postoperative complications, and rapid discharge.

Does myringosclerosis affect the success of butterfly myringoplasty?

OBJECTIVES: Butterfly inlay myringoplasty is a simple and practical surgical technique used in the repair of tympanic membrane perforation offering good outcomes in terms of hearing. The present study evaluates the effects of myringosclerosis on the success of surgery by reviewing demographic data, perforation size and hearing outcomes of patients undergoing endoscopic inlay butterfly myringoplasty due to chronic otitis media. METHODS: The study included 75 patients who underwent endoscopic inlay butterfly myringoplasty with the diagnosis of chronic suppurative otitis media in the Department of Otorhinolaryngology at Firat University Faculty of Medicine between March 2018 and July 2021. The patients were divided into three groups as the following. Group I: Patients without a myringosclerotic focus in the neighborhood of tympanic membrane perforation, Group II: Patients with a less than 50% myringosclerotic focus in the neighborhood of tympanic membrane, and Group III: Patients with a more than 50% myringosclerotic focus in the neighborhood of tympanic membrane. RESULTS: The comparison of all preoperative and postoperative parameters and the reduction in air-bone gap between the groups did not show statistically significant difference (p>0.05). The comparison of air-bone gaps between preoperative and postoperative measurements showed a statistically significant difference in all groups (p<0.05). The grafting success rate was 100% in Group I, 96.4% in Group II, and 95.6% in Group III. The mean operation time was 28.57±2.54 min in Group I, 32.14±2.44 min in Group II, and 30.69±3.43 in Group III; there was a statistically significant difference only between Group I and Group II (p = 0.001). CONCLUSIONS: The graft success rate and hearing gain in patients with myringosclerosis were similar to those in patients without myringosclerosis. Therefore, butterfly inlay myringoplasty is applicable to patients with chronic otitis media regardless of the presence or absence of myringosclerosis.

Comparison of Computed Tomography-Based Artificial Intelligence Modeling and Magnetic Resonance Imaging in Diagnosis of Cholesteatoma.

BACKGROUND: In this study, we aimed to compare the success rates of computed tomography image-based artificial intelligence models and magnetic resonance imaging in the diagnosis of preoperative cholesteatoma. METHODS: The files of 75 patients who underwent tympanomastoid surgery with the diagnosis of chronic otitis media between January 2010 and January 2021 in our clinic were reviewed retrospectively. The patients were classified into the chronic otitis group without cholesteatoma (n=34) and the chronic otitis group with cholesteatoma (n=41) according to the presence of cholesteatoma at surgery. A dataset was created from the preoperative computed tomography images of the patients. In this dataset, the success rates of artificial intelligence in the diagnosis of cholesteatoma were determined by using the most frequently used artificial intelligence models in the literature. In addition, preoperative MRI were evaluated and the success rates were compared. RESULTS: Among the artificial intelligence architectures used in the paper, the lowest result was obtained in MobileNetV2 with an accuracy of 83.30%, while the highest result was obtained in DenseNet201 with an accuracy of 90.99%. In our paper, the specificity of preoperative magnetic resonance imaging in the diagnosis of cholesteatoma was 88.23% and the sensitivity was 87.80%. CONCLUSION: In this study, we showed that artificial intelligence can be used with similar reliability to magnetic resonance imaging in the diagnosis of cholesteatoma. This is the first study that, to our knowledge, compares magnetic resonance imaging with artificial intelligence models for the purpose of identifying preoperative cholesteatomas.

Is it useful to use computerized tomography image-based artificial intelligence modelling in the differential diagnosis of chronic otitis media with and without cholesteatoma?

OBJECTIVE: Cholesteatoma is an aggressive form of chronic otitis media (COM). For this reason, it is important to distinguish between COM with and without cholesteatoma. In this study, the role of artificial intelligence modelling in differentiating COM with and without cholesteatoma on computed tomography images was evaluated. METHODS: The files of 200 patients who underwent mastoidectomy and/or tympanoplasty for COM in our clinic between January 2016 and January 2021 were retrospectively reviewed. According to the presence of cholesteatoma, the patients were divided into two groups as chronic otitis with cholesteatoma (n = 100) and chronic otitis without cholesteatoma (n = 100). The control group (n = 100) consisted of patients who did not have any previous ear disease and did not have any active complaints about the ear. Temporal bone computed tomography (CT) images of all patients were analyzed. The distinction between cholesteatoma and COM was evaluated by using 80% of the CT images obtained for the training of artificial intelligence modelling and the remaining 20% for testing purposes. RESULTS: The accuracy rate obtained in the hybrid model we used in our study was 95.4%. The proposed model correctly predicted 2952 out of 3093 CT images, while it predicted 141 incorrectly. It correctly predicted 936 (93.78%) of 998 images in the COM group with cholesteatoma, 835 (92.77%) of 900 images in the COM group without cholesteatoma, and 1181 (98.82%) of 1195 images in the normal group. CONCLUSION: In our study, it has been shown that the differentiation of COM with and without cholesteatoma with artificial intelligence modelling can be made with highly accurate diagnosis rates by using CT images. With the deep learning modelling we proposed, the highest correct diagnosis rate in the literature was obtained. According to the results of our study, we think that with the use of artificial intelligence in practice, the diagnosis of cholesteatoma can be made earlier, it will help in the selection of the most appropriate treatment approach, and the complications can be reduced.

Can prestin level be a biomarker for determining sensorineural hearing loss?

OBJECTIVE: To determine prestin levels in patients with sensorineural hearing loss and to assess whether the prestin level could be a determining factor in predicting sensorineural hearing loss. MATERIAL AND METHODS: The study was carried out with patients that presented to the Department of Otorhinolaryngology of Firat University. Patients were divided into four groups of 30 subjects. Group 1: individuals aged ≥55 years with no hearing loss (control group); Group 2: individuals aged 20 to 55 years with no hearing loss (control group); Group 3: individuals aged 20 to 55 years with sensorineural hearing loss; Group 4: individuals aged ≥55 years with presbycusis. Following an audiometry examination, 5 cc blood was taken from all patients to assess serum prestin levels. RESULTS: Prestin levels were 445.32 pg/mL in Group 1; 452.79 pg/mL in Group 2; 123.64 pg/mL in Group 3; and 79.54 pg/mL in Group 4. No difference was found between the serum prestin levels of the younger patients with hearing loss (Group 3)] and of the patients with presbycusis (Group 4) (p=0.084). No difference was found between the serum prestin levels of the younger (Group 1) and the older (Group 2) patients with presbycusis (p=0.399). Significant differences (with higher levels in the control groups) were found in between the prestin levels of between Group 3 (the younger patients with sensorineural hearing loss) and Group 2 (younger controls), and between Group 4 (older patients with presbycusis) and Group 1 (older controls) (p<0.001 and p <0.001, respectively). CONCLUSION: Serum prestin levels can be used as biomarkers for assessing patients with presbycusis and sensorineural hearing loss. They can also be used together with audiometry tests to predict the patient's potential level of hearing loss.

Vestibular functions in patients with idiopathic sudden sensorineural hearing loss and its relation to prognosis.

OBJECTIVE: Because of the anatomically close relationship between the cochlea and the vestibular organs, cochlear function disorders may be accompanied by vestibular disorders. This study aimed to evaluate vestibular functions in patients with idiopathic sudden sensorineural hearing loss using VEMP, caloric test, and VNG test battery and its relation to prognosis. MATERIALS AND METHODS: For this study, 42 patients aged 18-55 years with idiopathic sudden sensorineural hearing loss and 30 volunteers who had no hearing and balance problems were included. Audiometry, cVEMP, oVEMP, caloric tests, and VNG tests were performed. Moreover, the effects of age, sex, time of admission, degree and configuration of hearing loss, accompanying vertigo, tinnitus, and ear fullness on improvement in hearing were evaluated. RESULTS: Of the 42 patients in the study group, 26 (56.52%) were male, 20 (43.48%) were female, and the mean age was 41.54 ± 12.23 years. Of the 30 individuals in the control group, 19 (63.3%) were male, 11 (36.7%) were female, and the mean age was 39.53 ± 13.03 years. There was no significant difference in the incidence of sudden sensorineural hearing loss in terms of sex and age, and the prognosis was better for female patients. Early admission to treatment was a factor of good prognosis; profound hearing loss, bilateral hearing loss and vertigo were factors of poor prognosis. Prognosis was better in patients with rising type audiogram configuration, while the prognosis was worse in patients with flat, descending and total hearing loss. Tinnitus and ear fullness had no effect on the prognosis. No anomalies were observed in VNG findings. Moreover, abnormal caloric response was higher in patients with profound hearing loss and total hearing configuration. Shortening was observed in cVEMP / oVEMP P1 and N1 latency after treatment. Furthermore, there was an improvement in abnormal responses after treatment. CONCLUSION: In this study, vestibular function was affected in patients with idiopathic sudden sensorineural hearing loss. The present study can help the development of a clinical strategy in the evaluation of the vestibular system in idiopathic SSNHL, patient follow-up, patient information, and the implementation of vestibular rehabilitation. Note that additional studies involving larger patients series are required.

Comparison of Changes in Nasal Skin Sensation After Primary and Revision Rhinoplasty Procedures Using Semmes-Weinstein Monofilament Testing.

BACKGROUND: Numbness of the nasal skin is one of the most common complications following rhinoplasty. OBJECTIVES: The present study investigated postoperative changes in nasal skin sensation among primary and revision rhinoplasty patients and evaluated the recovery outcomes for both groups. METHODS: A prospective, randomized blinded study was undertaken involving 100 primary and 34 revision open rhinoplasty patients and 50 volunteers as control group. Semmes-Weinstein monofilament testing was performed on 7 designated nasal points preoperatively and at postoperative months 1, 3, 6, and 12, and the results were evaluated. RESULTS: Among the primary rhinoplasty patients, the change in reduced sensation on pressure to the tip and infratip over time was significant (P < 0.001), whereas there was no statistically significant difference for the other points. Among the revision rhinoplasty patients, the change in reduced sensation on pressure to the tip, infratip, and base of columella over time was significant (P < 0.001), whereas there was no statistically significant difference at the other points. In a comparison of the revision and primary rhinoplasty patients at all timepoints, a statistically significant reduction in sensation was noted on the application of pressure to all points in the revision patient group (P < 0.001). CONCLUSIONS: This study found that the sense of touch on pressure returned to normal, aside from at the tip and infratip, by the end of month 12 in primary rhinoplasty patients. The revision rhinoplasty patients, in turn, were observed to have reduced sensation on pressure by the end of month 12, with the greatest reduction at the tip, infratip, and columellar base.

Minimal Invasive Radioguided Ectopic Parathyroidectomy in Upper Mediastinum

In this study we wanted to present a case with the history of multiple previous neck explorations and persisting upper mediastinal ectopic parathyroid adenoma who underwent a successful operation with radioguided minimal invasive approach.

Tonsillar Kaposi Sarcoma in an HIV-Negative Patient: A Case Report.

Kaposi's sarcoma (KS) is a rare malignancy associated with AIDS and usually affects skin. The most common causative agent is the Human Herpes Virus Type 8 (HHV-8). In the literature, there are few case reports about KS with no association to AIDS. In this case report, we report a 72-year-old HIV (-) woman who presented to our clinic with a complaint of fast swelling in the right palatine tonsil and was histopathologically diagnosed as tonsillar KS.

Normalization of Bone Conduction Auditory Brainstem Evoked Responses in Normal Hearing Individuals.

OBJECTIVES: Auditory brainstem responses (ABR) are used to evaluate the peripheral and central functions of the auditory tract. Air and bone-conduction auditory stimuli are used to evaluate the type and degree of hearing loss. The wave latencies and interpeak latencies (IPLs) are the important diagnostic data in ABR tests. Gender and age of the patients are some of the factors affecting these latencies. This study investigated the effects of age and gender on the wave and IPLs of bone-conduction ABR. MATERIALS AND METHODS: One hundred healthy individuals (50 women and 50 men) aged between 10 and 60 years were enrolled into this study, and both ears of all subjects (200 ears total) were included in the assessments. Based on their age, the subjects were equally divided into five groups, and each group consisted of 10 men and 10 women. RESULTS: The findings showed a significant difference in wave latencies and IPLs between the two genders (p<0.05). Depending on stimulus intensity, wave latencies also showed statistically significant differences between the age groups (p<0.05). However, no significant difference was noted between the age groups regarding IPLs. CONCLUSION: Normative values that covered wave latencies and IPLs evoked at stimulus intensities of 50, 30, and 10 dB nHL were established for the clinical use and use as a reference for the bone-conduction ABR testing procedure.

The Protective Effect of Cortexin on Cisplatin-Induced Ototoxicity.

OBJECTIVE: The aim of this report is to evaluate whether cortexin provides any protective activity against ototoxicity of cisplatin. MATERIALS AND METHODS: The study was performed on 30 healthy adult Wistar Albino rats, and rats were randomly divided into three groups of ten. Group I (Control group) was given intraperitoneal (ip) saline solution 1 mL/day. Group II (Cisplatin group) was given ip cisplatin for 2 days at doses of 10 mg/kg. Group III (Cisplatin + Cortexin group) was given ip cisplatin for 2 days at same doses with ip cortexin 2 mg/day for 7 days. Before and on the fourth day of the study, all subjects underwent auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE) tests. At the end of fourth day, half of the subjects in all three groups were decapitated, and their cochlea were removed for histopathologic examination. On the eighth day, tests of the remaining subjects and histopathological examinations were repeated. RESULTS: ABR tests on the fourth and eighth days showed elevations in the mean hearing thresholds of Groups II and III compared to Group I (p < 0.05). DPOAE tests revealed a loss in emission values on the fourth and eighth days of the study compared to the baseline in Groups II and III. Comparison of Groups II with III showed that emission loss was higher in Group II at both time points, and the difference was more pronounced on the eighth day. Histopathological findings supported these tests. CONCLUSION: Cortexin provide protective activity against cisplatin-induced ototoxicity.

The role of insulin-like growth factor I-II receptor on development of pleomorphic adenoma.

Pleomorphic adenoma is a slow-growing salivary gland tumor frequently arising from the parotid gland. In this study, we investigated the role of the insulin-like growth factor I-II receptor (IGFI-IIR) levels on the development of parotid gland pleomorphic adenomas. The study included 20 males and 20 females who had superficial parotidectomy with a histopathological diagnosis of pleomorphic adenoma in Firat University Otorhinolaryngology Clinic between 2000 and 2011. The ages of the patients ranged between 20 and 50 years. The control tissues were obtained unilaterally from the parotid glands of five female and five male cadavers during autopsy, and consisted of 0.5 × 0.5 cm sized normal parotid gland tissues. The expression of IGFI-IIR were measured in both tumor and tumor-free normal parotid tissue in the study group while only the normal parotid tissues were studied in the cadavers. Primary polyclonal antibodies against IGFI-IIR were used with "Streptavidin-Biotin Complex" method for immunohistochemical staining of both the study and the control groups' tissue sections. In this study, the IGFI-IIR levels were found significantly higher in the pleomorphic adenoma tissue (p < 0.05). In addition, IGFI-IIR expression was greater in normal parotid tissues of the study group when compared to the normal parotid tissues of the cadavers. However, the difference was not statistically significant (p > 0.017). Greater expression for IGFI-IIR in pleomorphic adenoma when compared to normal parotid tissues of the patients and the cadavers suggests that IGFI-II may be important factors in the development of pleomorphic adenoma.

Endoscopic Removal of a Dental Implant From Maxillary Sinus.

The displacement of a dental implant into the maxillary sinus during surgery or after a period of use is a complication defined in the dental implant clinical practice. This complication arises primarily from inadequate bone height and peri-implant infection. Specifically, foreign objects in the maxillary sinus can cause sinusitis via impaired mucociliary flow and foreign body reactions, so they must be removed. Caldwell-Luc, transnasal, and intraoral endoscopic sinus surgeries have all been used to remove such foreign bodies and lesions from maxillary sinuses. In this article, the authors present the case of a patient whose dental implant slipped into the right maxillary sinus after a period of use and describe the endoscopic removal of said implant via an intraoral approach. The endoscopic removal of the dental implant from the maxillary sinus proved to be a safe, reliable, and minimally invasive method.

Endoscopic cartilage butterfly myringoplasty in children.

OBJECTIVE: The present study evaluated the results of the graft success rate and hearing gain of children who underwent endoscopic inlay butterfly myringoplasty due to chronic otitis media. METHODS: The study included 32 pediatric patients aged between 8 and 17, who had endoscopic inlay butterfly myringoplasty with the diagnosis of chronic otitis media between September 2012 and January 2015 in Elazig Training and Research Hospital Otorhinolaryngology Clinic and Firat University Otorhinolaryngology Clinic. All patients' demographics, perforation size, and hearing status were examined. RESULTS: Tympanic membrane perforation was ≤3mm in 12 patients and between 3 and 6mm in 20 patients. The air-bone gap (ABG) of the patients was 18.5±6.29dB preoperatively, 8.81±3.53dB postoperatively second month, 8.09±3.55dB postoperatively sixth month, and 7.96±3.32dB postoperatively 12th month. Two (6.3%) of the patients had postoperative myringitis. Two (6.3%) patients had recurrent perforation in the postoperative follow-ups. CONCLUSION: In children, endoscopic inlay butterfly tympanoplasty is a surgical technique with short duration, high graft success, effective hearing reconstruction, and high levels of postoperative patient comfort.

Endoscopic tympanoplasty.

Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.

Evaluation of the Relationship Between the Air-Bone Gap and Prolonged ABR Latencies in Mixed-Type Hearing Loss.

OBJECTIVE: The aim of this study was to determine the air-bone gaps in adults with mixed-type hearing loss using air-conduction auditory brainstem response (ABR) latencies. MATERIALS AND METHODS: Thirty adults with mixed-type hearing loss (study group) and 30 adults with normal hearing (control group) were included in this study. Before performing ABR measurements, ear, nose, and throat examinations, pure tone audiometry, speech audiometry, acoustic immittance audiometry, and transient evoked autoacoustic emission testing were performed for all participants. Absolute latencies of I, III, and V waves and interpeak latencies (IPL) at 90 decibel hearing level dB nHL were evaluated and compared with air-bone gap results. RESULTS: ABR latencies using click and tone-burst stimulation were obtained and found to be longer in the mixed-type hearing loss group than in the normal hearing group (p<0.05). A moderate positive relationship was detected between the air-bone gap and wave III/V latencies at 0.5/1 kHz, I-V/I-III/III-V IPL at 1 kHz. Only one strong relationship was found between 1 kHz air-bone gap and I-V IPL. CONCLUSION: In this study, the magnitude of the air-bone gap could not determined using prolonged ABR latencies. Delays in ABR latencies were observed, but prolonged ABR latencies was not helpful for calculating the air-bone gap on mixed-type hearing loss.