Managment of orbital complications of sinusitis.

Purpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics may be appropriate when close monitoring is possible. Surgery may be indicated when there has been no improvement within 48 hours of intravenous treatment, loss of visual acuity (under 8/10), and a non-medial abscess.

Radiologic and surgical findings in chronic suppurative otitis media.

Our aim in this study was to evaluate the efficiency of preoperative temporal bone computed tomography (CT) in detecting pathologic conditions in patients with chronic suppurative otitis media (CSOM). The intraoperative findings and temporal bone CT results of 350 patients who were diagnosed with CSOM between September 1, 2010, and June 1, 2013, were compared. Comparison parameters were as follows: the presence of cholesteatoma, erosion of the outer ear bone canal, erosion of the middle ear chain, erosion of the dural plate, erosion of the lateral semicircular canal, erosion of the sigmoid sinus wall, and dehiscence of the facial canal. The contribution of CT was limited in showing the outer ear canal destruction, dural plate destruction, facial canal destruction, lateral semicircular canal destruction, and destruction of the sigmoid sinus wall. However, CT was more sensitive in detecting cholesteatoma and erosion of the ossicular chain. These results indicate that preoperative CT of patients with CSOM serves as an important guide for otolaryngologists, although there are limitations in the evaluation of the CT results.

Managment of orbital complications of sinusitis / Tratamento das complicações orbitais da sinusite

Purpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics ...

Objetivo: Relatamos abordagens clínicas dos departamentos de oftalmologia e otorrinolaringologia para tratar complicações orbitais da sinusite. Uma revisão em profundidade literatura é discutida. Métodos: Foram analisados retrospectivamente os prontuários de 51 pacientes no período de janeiro de 2008 a janeiro de 2014. Os registros foram avaliados quanto à idade, sexo, tipo de complicação orbital, sintomas, fatores predisponentes, estudos de imagem, tratamento médico e cirúrgico, resultados da cultura microbiológica e seguimento. Foi utilizado o programa SPSS versão 15.0 (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) para a análise estatística. Resultados: Cinquenta e um pacientes preencheram os critérios, com os registros médicos disponíveis, para o estudo (29 do sexo masculino, 22 do sexo feminino). Trinta e dois (62,7%) foram diagnosticados com celulite presseptal e 19 (37,3%), com celulite posseptal. Depois de uma avaliação detalhada, 15 foram diagnosticados como abscesso subperiosteal (SPA), 4 eram celulite orbitária. A idade e sexo foi similar para ambos os grupos. Cinco pacientes com abscesso subperiosteal medial foram tratados com cirurgia endoscópica, um paciente com abscessso subperiosteal inferior foi tratado com cirurgia externa, 6 pacientes com outras localizações foram tratados com a combinação de cirurgia endoscópica e cirurgia externo. Todos os pacientes apresentaram eritema e edema periorbital. Tempo de internação hospitalar e a duração dos sintomas foi similar em ambos os grupos. A acuidade visual foi entre 1/10 a 10/10 (média de 7/10) e estatisticamente significante para os grupos celulite presseptal e posseptal (p<0,001). Todos os pacientes receberam antibióticos por via intravenosa, no primeiro dia ...

Long-term effect of radiofrequency turbinoplasty in nasal obstruction.

The aim of this retrospective study is to investigate long term (two years) effect of radiofrequency tissue volume reduction (RFVTR) on nasal obstruction associated with inferior turbinate hypertrophy, which is not respond to medical treatment. This retrospective study carried out on 98 patients with nasal obstruction treated by RFVTR (56 males, 42 females, from 17 to 70 years of age). Visual analogue scales (VAS) and nasal endoscopic view score (NES) were used for nasal obstruction to evaluate the efficacy of the treatment. Results of one, three, six, twelve and twenty four months after RFVTR treatment were compared with pre-exposure values. Turbinate edema and nasal obstruction in the treated patients were recovered after one month of treatment (p < 0.01). Maximum improvement were determined at the end of third month (p < 0.01). However, eficacy of RFVTR declined twelve months after treatment. Final percentage of imrovement was found as 51 % at the end of second year of treatment because of co-factors was not eliminated by some patients. On the other hand, no statistical significant difference was observed between the right and left nasal cavity (p < 0.001). In conclusion, the result of this study indicated that patients who have not eliminate co-factors such as smoking, obesity and allergic rhinitis may need re-application of RFTVR. However, further studies on radiofrequecy energy level and elimination of other co-factors are necessary to illuminate the eficacy of RFVTR.

An unusual foreign body in frontal sinus: silicone tube.

Foreign bodies in paranasal sinuses are very rare and more than half of them are encountered in maxillary sinus. Most of the foreign bodies are associated with maxillofacial trauma. Foreign body in the frontal sinus is even a rarer condition. Foreign bodies usually present with chronic symptoms and complications due to the delayed diagnosis. In this article, we report an unusual case of mucocele resulting from silicone nasolacrimal duct tube in right frontal sinus which was left or forgotten in nasal cavity after external dacryocystorhinostomy operation. The patient was treated surgically and her symptoms resolved after surgery.

The effect of corticosteroid against streptomycin ototoxicity.

The aim of this experimental study was to determine the possible protective role of corticosteroid in prevention of streptomycin-induced ototoxicity. Twenty-eight adult Wistar albino rats were divided into 4 groups: control (n = 7), streptomycin (n = 7), corticosteroid (n = 7), and streptomycin + corticosteroid (n = 7). Rats were tested with distortion product otoacoustic emissions (DPOAEs) in the beginning and at the end of the study. The animals in all groups were killed under general anesthesia on the 45th day after the last DPOAE measurements. Hearing results were analyzed statistically to determine differences in amplitudes of DPOAE. In addition, the cochleas of each rat were evaluated by histopathologic and immunohistochemical examination. Significant difference was not observed in cochlear hair cells in the control and corticosteroid groups, whereas severe degeneration of hair cells and increased apoptotic cells were observed in the streptomycin group. Moderate degeneration was observed in the streptomycin + corticosteroid group. The hair cells were partially intact. DP-gram of the streptomycin and streptomycin + corticosteroid groups was significantly deteriorated (P < 0.05). The coadministration of steroids with streptomycin, which has a serious ototoxic effect, did not lead to a limitation of this harmful effect.

Mental health and quality of life in patients with chronic otitis media.

The present study focused on the comparison of mental health and quality of life (QoL) between chronic otitis media (COM) patients and the hearing population. The patients with chronic otitis media and healthy control group were enrolled in the study. The duration and severity of the auditory impairment were recorded. In addition to hearing loss (HL), the findings of each patient's other ear disorders (ear discharge and tinnitus) were also recorded. In both the groups, psychological symptom profile and health-related QoL were evaluated and compared using a sociodemographic questionnaire, the Symptom Check List 90-Revised Form (SCL-90-R), and the Short Form-36 (SF-36). According to SCL-90-R, somatization (p < 0.001), interpersonal sensitivity (p < 0.001), depression (p < 0.001), phobic anxiety (p < 0.001), and other subscores, and also global severity index score (p < 0.001) were significantly high in patient group when compared to the control group. The patients with COM reported significantly lower levels of QoL in terms of physical role difficulty (p < 0.001), general health perception (p < 0.004), social functioning (p < 0.001), and mental health (p < 0.017) than those of control subjects. Our results indicated that COM patients with mild or moderate HL have poorer life quality and higher psychological problems. Psychological well being should be also considered in assessment of COM patients in addition to the clinical evaluation and audiological tests.

Hemangioma arising from external jugular vein mimicking neck mass.

Hemangiomas are common benign tumors which can develop in any part of the body. Despite their common nature, hemangiomas arising from blood vessels are very rare. In this article, we present a very rare case of hemangioma which was originated from external jugular vein. The hemangioma was totally excised after the external jugular vein was ligated from both sides and no complication was observed.

Congenital os vomer agenesis: case report and literature review.

Defects of the nasal septum occur as a result of a variety of causes, including tuberculosis, irritation, neoplasia, trauma, infection, and chronic inflammatory diseases. Congenital os vomer agenesis as a cause is very rare. We report the case of a 28-year-old man with a defect in the posteroinferior part of the nasal septum that was discovered incidentally during a routine endoscopic examination. The patient was diagnosed with congenital os vomer agenesis, and the diagnosis was confirmed by computed tomography. We discuss the features of this case and review the literature on this rare anomaly.

Ganglioglioma in the nasal cavity: a case report.

Ganglioglioma is a tumor containing both astrocytic and neuronal components. It may occur any where in the central nervous system and spinal cord but is only encountered rarely. Nasal glial heterotopia (also known as ''nasal glioma''), is a rare developmental abnormality seen in a wide age group. Gangliogliomas may also manifest as a nasal glial heterotopia, and neurogenic tumors should be considered in the presence of a nasal mass. In this article, we present a case of ganglioglioma located in the right-nasal cavity. The mass was excised totally through an endoscopic approach. The ganglioglioma developed on a nasal glial heterotopia base. To our knowledge, a ganglioglioma arising from the nasal cavity has not been described previously in the literature.

Tuberculous parotitis: a review of seven cases.

OBJECTIVES: Tuberculous parotitis is rare even in countries where tuberculosis is widespread. We evaluated seven patients with tuberculous parotitis together with clinical and histopathologic findings, and management. PATIENTS AND METHODS: In a period of 13 years, seven patients (5 males, 2 females; mean age 32 years; range 23 to 47 years) were diagnosed and treated for tuberculous parotitis. All the patients had a clinical suspicion of a parotid gland tumor. RESULTS: The lesions were localized on the left in four patients, and on the right in three patients. The duration of disease varied from seven months to three years. The masses were localized, mobile, and measured 3 to 6 cm in diameter; one was fistulized. There was no evidence for active pulmonary tuberculosis. Chest radiograms showed old tuberculous lesions in two patients. The PPD skin test results were positive (>12 mm induration) in five patients (71%). Computed tomography or magnetic resonance imaging obtained in five patients showed mass formation suggesting a benign parotid gland tumor. Fine-needle aspiration cytology performed in three patients and cultivation performed in the fistulized case were all non-diagnostic. Superficial parotidectomy was performed in six patients and enucleation was performed in one patient. Histopathologic examination showed tubercles composed of macrophages, epithelioid cells and Langhans giant cells, and central caseous necrosis. Following diagnosis, all patients were treated with a four-drug chemotherapy regimen. There was no evidence for recurrence within a mean of 15-month follow-up. CONCLUSION: Tuberculosis of the parotid gland should be considered in the differential diagnosis of patients presenting with a solitary tumor in the parotid gland.

Effects of antineoplastic agents on the peripheral nerves under a surgical tissue expansion procedure: an experimental study.

BACKGROUND: Elongation of peripheral nerve by the use of a tissue expander is helpful to repair nerve defects. This study was designed to investigate the effects of some antineoplastic agents on the peripheral nerves under a surgical tissue expansion procedure. MATERIALS AND METHODS: Twenty-five Wistar rats were used in this study. Following the exposition of the sciatic nerve and placement of two 10/0-nylon sutures in the epineurium 20 mm apart, a tissue expander was then placed under it. Inflation of the expander was immediately accomplished by the separate percutaneous injections of 6, 6, and 8 ml for every 3 min under general anesthesia. The expander was fully deflated at the end of each 3 min The distance between two sutures was measured 1 h later to measure the rate of elongation. Rats were randomly divided into five groups (according to the administered drugs), each consisting of five rats (10 sciatic nerves). Normal saline (1 ml) in the control group (group I), cyclophosphamide (15 mg/kg) in the group II, cisplatinum (3 microg/kg) in the group III, mitomycin-C (0.5 mg/kg) in the group IV and 5-fluorouracil (10 mg/kg) in the group V were injected intravenously. Intravenous injections of drugs were performed via the tail vein 30 min before expansion, 48 and 96 h after removal of expander. The incision was reopened on the third and seventh postoperative days, and five sciatic nerves of each group were exposed and then the pinching test was performed to measure regeneration distance. Electroneurographic changes were recorded. The expanded portion of the sciatic nerve between two sutures was harvested for histological evaluation. RESULTS: There is no significant difference between the elongation rates of all groups (P < 0.05). Histologic evaluation showed that inflammatory changes, vacuolization, intraneural edema, demyelination, axonal changes in the control group, the cisplatinum group, and the mitomycin-C group. These changes were significantly decreased in the cyclophosphamide group and the 5-fluorouracil group. In the cyclophosphamide group and the 5-fluorouracil group, the amplitude of compound action potential (CAP) values were significantly higher and the latency was significantly shorter (P > 0.05). CONCLUSION: We believed that cyclophosphamide and 5-fluorouracil may be helpful in tissue expansion of peripheral nerves, by decreasing the effects of the ischemia-reperfusion injury on the expanded peripheral nerves.

Occupational safety: effects of workplace radiofrequencies on hearing function.

BACKGROUND: The effects of radio frequency (RF) and microwave radiation on humans have been the subject of continuous investigation. Clinical investigations related to occupational RF/microwave exposure have been reported by investigators (1). Since one of the major groups occupationally exposed to RF and microwave radiation includes those working in radio broadcasting and TV transmitter stations, this study investigates whether RF affects auditory systems of people exposed to RF. METHODS: The study is carried out with people working in radio broadcasting stations and living in employee residential houses close to the broadcasting stations. All subjects in the control group were similar in age, work regime, socioeconomic status, and lack of experience in working with RF sources. Brainstem Evoked Response Audiometer (BERA) and Pure Tone Audiometry (PTA) were used to measure the effects of RF under investigation on hearing functions of the subjects. In BERA measurements, I-III, III-V and I-V interpeak latencies were evaluated. In pure tone audiometric measurements, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and 8000 Hz frequencies of hearing threshold were measured in subjects of experimental and control groups. Interpeak latencies and bone conduction hearing thresholds of subjects in the experimental group were compared with those of the control group. RESULTS: BERA results showed that I-III, I-V and III-V interpeak latencies of people occupationally exposed to RF were not higher than subjects in control groups (p>0.05). Results of BERA indicated no statistically significant differences between exposure and control subjects. In audiometric evaluation, hearing threshold of people occupationally exposed to RF were found higher than the control group subjects for frequencies of 4000 Hz and 8000 Hz in terms of bone and air conduction of right and left ear (p < 0.01). CONCLUSIONS: The results of traditional audiometer indicated that RF promotes sensorineural hearing loss and affects cochlea parts related to 4000 Hz and 8000 Hz. These findings may have immediate implications and considerations for workplace safety in order to provide an occupationally safe environment to employees working in such settings.

[Clinical assessment of patients with chronic otitis media with cholesteatoma]. / Kolesteatomlu kronik otitis media: Olgularin klinik degerlendirilmesi.

OBJECTIVES: We evaluated clinical features and treatment results of patients with chronic otitis media (COM) with cholesteatoma. PATIENTS AND METHODS: The study included 83 patients (53 males, 30 females; mean age 27.5 years; range 7 to 60 years) who were treated for COM with cholesteatoma. All patients underwent otoscopic examination, audiometric investigation, temporal bone computed tomography, and when necessary, cranial tomography. Open or closed mastoidectomy was performed depending on the extent of cholesteatoma and perioperative appearance of the ear. RESULTS: Open- and closed-technique mastoidectomies were performed in 64 and 19 patients, respectively. Ossicular chain defects were observed in 90.3% of patients, and 9.7% had no detectable ossicular chain. Cranial complications were present in 28%. Of patients who had undergone open mastoidectomy, 75% had dry ears, 11% had recurrent ear discharge, and 14% required revision mastoidectomy because of recurrence. Of those who had been treated by closed-technique, 79% had dry ears, whereas 21% required revision mastoidectomy. Recurrent cholesteatoma was detected in 85% of patients during revision mastoidectomy. CONCLUSION: We prefer open-technique mastoidectomy in chronic otitis media patients with extensive cholesteatoma, bone destruction, and hearing impairment. This choice mainly relies on the socioeconomic status of patients and difficulty in having patient compliance with follow-up controls.

The effect of benzalkonium chloride on rabbit nasal mucosa in vivo: an electron microscopy study.

In this study we investigated the histopathological changes of nasal mucosa after the use of topical benzalkonium-chloride solution. In the study, 28 male New Zealand white rabbits were used. The animals were divided into two groups. In the first group, 50 micro l of 0.001% benzalkonium-chloride solution was sprayed into the right nostril and 50 micro l of 0.9% saline into the left twice daily for 14 days. In the second group, the same solutions were applied twice daily for 28 days. All of the biopsies from each nasal cavity were processed for electron microscopy. In the nostrils treated with 0.001% benzalkonium chloride, there were areas with obvious squamous cell metaplasia. Some cells showed broken cristae of the mitochondria. Degenerative changes in the supportive and olfactory cells, deformation of nuclei and the increase of heterochromatin were observed. The present investigation has shown that the application of topical benzalkonium chloride does induce degenerative morphologic changes in the nasal mucosa in rabbits in vivo.

Evaluation of brainstem auditory evoked response audiometry findings in children with tuberculous meningitis at admission.

OBJECTIVE: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. METHODS: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V, I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). RESULTS: The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. CONCLUSION: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.