Evaluation of the Relationship Between Facial Nerve and Lateral Semicircular Canal in the Posterior Tympanotomy Approach.

BACKGROUND: To clinically and radiologically evaluate the relationship between the facial nerve and the lateral semicircular canal during posterior tympanotomy. METHODS: Patients who received cochlear implants between 2010 and 2020 were included in the study. The relationship between the facial nerve and the lateral semicircular canal was classified into 3 types by evaluating the axial section computed tomography images. If the facial nerve passed medially without contacting the lateral semicircular canal dome, it was classified as type 1; if the facial nerve passed by contacting the medial border of the lateral semicircular canal dome, it was classified as type 2; and if the facial nerve contacted the lateral border of the lateral semicircular canal dome or passed more laterally, it was classified as type 3. RESULTS: In total, 309 ears of 257 patients [139 males (54.1%) and 118 females (45.9%)] were included in the study. Ninety-three (30.1%) of the ears were classified as type 1, 179 (57.9%) were type 2, and 37 (12%) were type 3. It was found that the combined posterior tympanotomy/endomeatal approach was used in 6 ears (1.9%), of which 4 were type 3, and 2 were type 2 (P=.006). CONCLUSION: Systematic evaluation of the relationship between facial nerve and lateral semicircular canal in computed tomography axial sections might help prevent facial nerve damage that can occur during posterior tympanotomy. It was concluded that type 3 ears should be evaluated in this respect, as a combined posterior tympanotomy/endomeatal approach may be required.

Effects of Glycerol Test on Resonance Frequency in Patients with Ménière's Disease.

OBJECTIVE: To evaluate resonance frequency (RF) values via dehydration effects in the inner ear caused by the glycerol test, which is used as a diagnostic method for Ménière's disease (MD). METHODS: Twenty adult patients with unilateral MD were included in the study. Before, and then at 1, 2, and 3 h after administration of glycerol (1 g/kg), pure-tone hearing levels (125-8,000 kHz) and multifrequency tympanometry tests were performed. As a control, the RF values of the ears of 25 healthy subjects (i.e., 50 ears) were compared to the affected and unaffected ears in the 20 MD patients. RESULTS: There was a significant difference between the RF values of affected and healthy ears before glycerol administration (p = 0.047). The RF values before and after glycerol administration into affected ears were compared. The average RF values decreased significantly from 748.0 ± 402.1 to 808.0 ± 410.1 Hz at 1 h after glycerol intake, and this value increased during the subsequent hours. There were no statistically significant differences between the pure-tone levels before and 1 h after glycerol administration, but a significant decrease was observed at 3 h. CONCLUSION: We suggest that MD has different inner-ear dynamics and normal RF values when compared to healthy ears. Furthermore, decreased inner ear pressure causes reduction of the mass effect and a stiffening of the annular ligament. We conclude that pre- and post-RF tests should be added to the test battery for diagnosis of MD.

Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière's Disease.

OBJECTIVE: To assess the relationship between ocular (oVEMPs) and cervical (cVEMPs) vestibular evoked myogenic potentials and audiometrically determined clinical stage in Ménière's disease (MD). METHODS: Thirty-four unilateral MD patients and 30 healthy volunteers were included in the study. Pure-tone hearing levels, oVEMPs, cVEMPs, and videonystagmography results were analyzed and compared between the groups. RESULTS: Both oVEMPs and cVEMPs were highly reproducible in the control group. At the early stages of MD, cVEMPs were particularly disturbed, while at the advanced stages both oVEMPs and cVEMPs were altered pathologically. In the study group, oVEMP and cVEMP amplitudes and interaural amplitude difference (IAD) statistically differed from those in the control sample. oVEMPs were absent in 7.7% of stage III and in 44.5% of stage IV MD patients, while cVEMPs were absent in 15.4% of stage III and in 54.5% of stage IV MD patients, respectively. In stage III and IV MD patients in whom oVEMPs and cVEMPs were obtained, IADs were increased. Caloric asymmetry was found in 64.7% of MD patients. Caloric weakness was more prominent in cases with advanced MD. CONCLUSION: VEMPs can be used for objective validation of the stage of MD.

The protective effect of metformin against the noise-induced hearing loss.

OBJECTIVE: To test the protective effect of metformin against noise-induced hearing loss. METHODS: 24 rats were included in the study. The first group was exposed to noise only, the second group took metformin, the third group was exposed to noise and took metformin, and the fourth group was neither exposed to noise nor took metformin as control group. After measurement of baseline DPOAE and ABR of rats, the metformin group and the metformin + noise group received 300 mg/kg/day metformin via gavage for 10 days. On the 11th day, group 1 and group 3 were exposured to white noise at 105 dB SPL for 15 h. After noise exposure, DPOAE and ABR measurements of all rats were repeated on days 1st, 7th, and 21st. At the end of the study, all animals were sacrificed and cochlear tissues were separated for immunohistochemical assessments. RESULTS: ABR threshold values and DPAOE measurements of groups 1 and 3 were deteriorated on the 1st day after noise, while deterioration in group 1 continued on 7th and 21st days, but normalized on 7th day in group 3. After immune staining, a significant immunoreaction was observed in the noise group, while the reaction in the noise + metformin group was close to the control group. CONCLUSION: Metformin has a protective effect on noise-induced hearing loss in rats. As a conclusion, it is determined that metformin protects from permanent threshold shift in rats. It can be considered a good alternative for protecting noise-induced hearing loss.

Otorhinolaryngologic Problems in Liver and Kidney Transplant Recipients.

OBJECTIVES: The aim of this study was to define the otorhinolaryngologic manifestations and clinical characteristics of patients who received kidney or liver transplants at a university hospital. MATERIALS AND METHODS: Medical records of patients who received a kidney or liver transplant between 2000 and 2013 and who were referred or applied to the ear, nose, and throat clinic were retrospectively reviewed. Otorhinolaryngologic complaints, signs, examination findings, and diagnoses of patients were noted. RESULTS: Our analyses included 540 visits to the ear, nose, and throat clinic by 101 liver and 191 kidney transplant recipients. Mean duration between date of transplant and otorhinolaryngologic examination was 747.9 ± 37.1 days. The most common complaint was rhinorrhea (n = 112), whereas the most common diagnosis was acute rhinosinusitis (n = 85). Acute upper respiratory tract infections, including rhinosinusitis, were diagnosed more frequently during the late postoperative period (ie, > 180 days after transplant). Epistaxis was more frequent during the first 30 days after transplant. CONCLUSIONS: A diverse variety of otorhinolaryngologic conditions, including emergencies and potentially life-threatening infections, were seen in our kidney and liver transplant recipients, both during the early and the late follow-up period. All transplant team members should be familiar with the clinical presentation of frequently seen otorhinolaryngologic diseases.

Audio-Vestibular Findings in Increased Intracranial Hypertension Syndrome.

OBJECTIVE: Idiopathic intracranial hypertension (IIH) can be manifested by audiological and vestibular complaints. The aim of the present study is to determine the audio-vestibular pathologies and their pathophysiologies in this syndrome by performing current audio-vestibular tests. MATERIALS AND METHODS: The study was performed prospectively on 40 individuals (20 IIH patients, 20 healthy volunteers). Pure tone audiometry, tympanometry, vestibular evoked myogenic potentials, and electronystagmography tests were performed in both groups and the results were compared. RESULTS: The mean age of both groups was found to be 30.2±18.7. There were 11 females and 9 males in each group. The study group patients had significantly worse hearing levels. Pure tone averages were significantly higher in both ears of the study group (p<0.05). Ten patients (50%) in the study group and one healthy volunteer (5%) had pathologic ENG, possibly related to central pathologies (p=0.008). Eight patients (40%) and one (5%) control had variable abnormal VEMP records (p=0008). CONCLUSION: Many IIH patients initially visit otolaryngology clinics since cochlear and vestibular systems are frequently affected in this condition. Our test results suggest inner ear pathologies in these patients. Higher incidence of inferior vestibular nerve and/or saccule dysfunction is detected as a novelty. Increased intracranial pressure may affect the inner ear with similar mechanisms as in hydrops.

Submandibular Gland Surgery: Our Clinical Experience.

OBJECTIVE: The aim of this study was to assess the demographic findings and surgical results of patients who underwent submandibular gland excision at a tertiary care center. METHODS: The clinical characteristics and histopathological results of 45 patients who had undergone submandibular gland excision between 1997 and 2014 were evaluated in detail. RESULTS: Twenty-eight (62.2%) and 17 (37.8%) patients presented with a complaint of a painful mass and painless mass, respectively. Histopathologic investigation of the surgical specimens revealed sialolithiasis in 14 patients (31.1%), chronic sialadenitis in 16 (35.6%), benign tumor in 12 (26.7%), malignant tumor in two (4.4%), and mucocele extravasation in one. As complications, permanent paralysis of the marginal mandibular branch of the facial nerve was seen in one patient (2.2%), temporary paralysis of the marginal mandibular branch of the facial nerve was seen in seven (15.6%), orocutaneous fistula was seen in one (2.2%), and temporary paralysis of the hypoglossal nerve was seen in one (2.2%). CONCLUSION: This study revealed that in patients presenting with complaints of a submandibular gland mass, sialolithiasis, sialadenitis, and benign masses were the mostly diagnosed disorders. Transcervical submandibular gland excision is a satisfactory procedure with low complication and recurrence rates when it is performed on selected patients and obeyed to surgical techniques.

Glycerol affects vestibular-evoked myogenic potentials and pure-tone hearing in patients with Ménière's disease.

CONCLUSION: The pure-tone audiometry results following glycerol administration indicated a positive effect on cochlear endolymphatic hydrops. Glycerol cervical vestibular-evoked myogenic potential (cVEMP) tests are a useful means of diagnosing saccular hydrops. There was no correlation between cVEMP and audiological results. OBJECTIVE: To document the changes in pure-tone hearing outcomes and cVEMPs in patients with Ménière's disease (MD) and 10 healthy volunteers before and after oral administration of glycerol. METHODS: Twenty-nine study group subjects were chosen with complaints of vertigo. cVEMP testing and pure-tone hearing level testing were performed before and at 1, 2, and 3 h after administration of glycerol. RESULTS: The means of the latencies, amplitudes, and difference ratio in 20 normal subject ears were determined. Based on these values, 9/29 MD-affected (MDA) ears (31%) had a unilaterally absent cVEMP. Compared with difference ratio values of the control groups there were significant differences in both latencies and amplitudes in MDA ears after glycerol administration. Before glycerol administration, there were significant differences between control and MDA ears on mean values of pure-tone hearing outcomes. Twenty patients in the MDA group showed significant pure-tone hearing outcomes after glycerol administration.

Short-term results of Neurelec Digisonic SP cochlear implantation in prelingually deafened children.

This paper examines the reports on the selection criteria and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. This study reported benefits from Neurelec Digisonic SP cochlear implant in auditory and speech perception outcomes. There has been a lack of studies into the additional factors such as level of the mothers' education and bilingualism, which is a factor that may have a significant effect on the success of cochlear implantation. This paper examines the reports on the reasons for the differences in performance and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. Meaningful Auditory Integration Scale and Meaningful Use of Speech Scale questionnaires were used just before 3, 6, 12, and 18 months following implantation. Electrode array was inserted without difficulty in all cases, with no complications to date. This is a retrospective and cross-sectional study and all the data were collected between March 2010 and December 2012. Auditory performance improved over time for up to 12 months after implantation. Our experience indicates that the Neurelec Digisonic SP cochlear implant system in children under the age of two is relatively safe and reliable. The Neurelec Digisonic SP device surgery can be performed without complications. Auditory performance results support the effectiveness of early implantation. These important findings further support the importance of professionals working very closely with parents or especially mothers and enhancing their involvement in achieving therapy goals to develop auditory skills and speech in young children following cochlear implantation.

[Normative values of middle ear resonance frequency in normal hearing adults]. / Normal isiten yetiskinlerde orta kulak rezonans frekansi normatif degerleri.

OBJECTIVES: This study aims to determine the normative values of middle ear resonance frequency in healthy adults. PATIENTS AND METHODS: Sixty adult volunteers (32 females, 28 males; mean age 31.8±7.1 years; range 21 to 46 years) with normal otoscopic examination, audiometry and electroacoustic immitancemetry findings were enrolled in the study. The middle ear resonance frequencies were calculated by multifrequency tympanometry. RESULTS: The mean resonance frequency for all volunteers was 999.6±134.9 Hz. The mean resonance frequency was 1020.8±140.6 Hz for the right ear, and 978.3±180.5 Hz for the left ear. The mean resonance frequencies for the right- and left-side were 1023.2±146.9 Hz and 912.5±177.8 Hz in males, and 1018.8±137.2 Hz and 1035.9±164.7 Hz in females, respectively. There was no statistically significant difference in the mean resonance frequency of the right ears between the males and females (p=0.9), whereas the mean resonance frequency of the left ears was statistically significantly higher in females (p=0.007). CONCLUSION: The middle ear resonance frequency values may vary according to the side of the ear or gender.

Surgical treatment of carotid body tumors.

OBJECTIVES: In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data. PATIENTS AND METHODS: Between November 2001 and May 2012, 10 patients (5 males, 5 females; mean age 53.2 years; range 27 to 80 years) who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded. RESULTS: Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting. CONCLUSION: Our study results suggest that (i) carotid body tumors should be handled with multidisciplinary approach; (ii) balloon occlusion test should be performed in all patients undergoing surgery; (iii) a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and (iv) pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.

Extensive cholesterol granuloma of the petrous apex presenting with facial paralysis and sensorineural hearing loss: a case report.

A cholesterol granuloma of the petrous bone is an expanding mass which contains fluids, lipids, chronic inflammatory cells, and cholesterol crystals surrounded by a fibrous lining. The goal of surgery is to provide drainage and ventilation of the affected area to prevent recurrences. In this article, we report a case of a 27-year-old man who was operated using the transmastoid infralabyrinthine approach to drain a cholesterol granuloma cyst.

The relationship of homocysteine, vitamin B12, folic acid levels with vertigo.

OBJECTIVES: In this study the relationship of serum homocysteine, vitamin B12, folic acid levels and peripheral vestibular dysfunction (PVD) was investigated. PATIENTS AND METHODS: Forty-one patients (31 females, 10 males; mean age 57.34±14.3 years; range 12 to 80 years) who admitted to Baskent University Hospital Ear Nose and Throat Department between the dates of April 2005 - December 2007 with complaint of vertigo were prospectively analyzed and diagnosed using audio-vestibular test, at the same time serum homocysteine, vitamin B12, folic acid measurements was done from the blood samples of patients. The patients were divided into three groups as Meniere's disease, vestibular neurinitis, and benign paroxismal positional vertigo (BPPV) according to the diagnoses and serum homocysteine, vitamin B12, folic acid levels of patients were compared to normal values in and between groups. RESULTS: Of the patients, 29.3% (n=12) were diagnosed with Meniere's disease, 36.6% (n=15) with vestibular neurinitis, and 34.1% (n=14) with BPPV. Serum homocysteine leves of patients were 12.42±3.56 umol/L, 11.32±4.14 umol/L and 10.72±2.95 umol/L (p>0.05) in Meniere's disease, vestibular neurinitis, and BPPV respectively; vitamin B12 levels were 371.58±141.35 pg/ml, 288.13±139.51 pg/ml, 352.14±150.41 pg/ml (p>0.05) respectively and folic acid levels were 8.76±3.2 umol/L, 10.63±6.59 umol/L, 8.8±3.18 umol/L (p>0.05) respectively. The values were similar in all patients. No statistically significant difference was found in and between groups comparing with normal values. CONCLUSION: This is the first prospective study investigating the relationship of serum homocystein, vitamin B12 and folic acid levels with PVD. We found that there is no relationship of homocysteine, vitamin B12, folic acid levels with PVD.

Are thiazides effective on hypertensive vertigo? A preliminary study.

OBJECTIVES: In this study, we aimed to investigate whether the symptoms of vertigo related to hypertension resulted from endolymphatic hydrops and the efficacy of the thiazides in the treatment. PATIENTS AND METHODS: A total of 24 vertigo patients without peripheric or central vestibular pathologies or hyperlipidemia were included. The study group comprised 15 patients with hypertension, including nine with regulated non-insulin-dependent diabetes mellitus (DM). The control group comprised nine patients without hypertension or DM. The patients in the study group received hydrochlorothiazide treatment. The European Evaluation of Vertigo Scale (EEVS) and Vertigo Handicap Questionnaire (VHQ), puretone audiometry, tympanometry, electronystagmography (ENG) for nystagmus tests, oculomotor tests, and caloric test were carried out initially and at three weeks for both groups. The results of the study group were compared to those of the control group. RESULTS: There was a statistically significant decrease in the scores of EEVS and VHQ at three weeks in the study group, compared to the baseline scores (for both groups p≤0.01). CONCLUSION: Our study results showed that thiazides alleviated vertigo symptoms in hypertensive patients, as measured by qualitative methods (i.e. EEVS, VHQ), but not with quantitative measurements (i.e. ENG).

Modified intraoral approach for removal of an elongated styloid process.

OBJECTIVE: To decrease the postoperative pain and the probability of intraoperative complications during intraoral removal of an elongated styloid process. STUDY DESIGN: A prospective, clinical trial. METHODS: Twenty-seven patients with 45 elongated styloid processes underwent surgery. There were 24 females and 3 males, with a mean age of 47.1 years. A simple visual analogue scale was used to assess pre- and postoperative pain. The length and medial and anterior angulation of each process were measured on lateral skull and Towne projection. During the surgery, after tonsillectomy was performed, the styloid process was identified and the process was stripped off proximally using a ring curette. The muscles and ligaments were in continuity with the periosteum, and attachments to the periostem were not disrupted. RESULTS: No intraoperative complications were seen. Only 2 of 45 procedures did not result in a decrease in pain, and a success rate of 95.6% was achieved by this modified surgical method. CONCLUSIONS: Excision of the styloid process without disturbing the attachments of the muscles and ligaments to the periosteum of the process is an important factor in relieving postoperative pain and complications.

Effects of various densities of middle ear fluids on acoustic immittance: experimental study.

OBJECTIVE: To study the effects of various densities of middle ear fluids on acoustic immittance and elucidate the characteristics of this study that might be beneficial for clinical use in otitis media with effusion. STUDY DESIGN: Experimental, in vivo model. MATERIALS AND METHODS: The study was performed on 12 ears of six white Vienna rabbits. Rabbits were placed in six positions: normal resting position (group 1); after drilling a hole into the tympanic bulla (group 2); filling the bulla with distilled water (group 3; density = 1000 g/cm(3)); filling the bulla with 8.4% bicarbonate solution (group 4; density = 1005 g/cm(3)); filling the bulla with Tonimer gel (group 5; density = 1035 g/cm(3)); and filling the bulla with glycerine (group 6; density > 1050 g/cm(3)). Acoustic immittance measurements were then made in vivo. During each measurement, volume, compliance, pressure, and gradient values were recorded. Analysis of variance, Student t-test, and Pearson correlation coefficient and multiple regression analyses were used for statistical evaluations of the data. RESULTS: Volume, compliance, and pressure values were obtained in all of the six measurements. A significant difference in volume was found between groups 1 and 2 (p < .001) and between the other four groups in this study (p < .001). With regard to compliance, group 2 was significantly different from groups 3, 4, 5, and 6 (p < .001). With regard to pressure, there was no intergroup (1 and 2) difference (p = .639); however, a significant difference (p < .001) was found between groups 1 and 2 and the other four groups. A significant difference was found between groups 3 and 6 (p = .006). A gradient value was obtained in all of the six measurements only for groups 1 and 2. In group 2, a significant rise in gradient was observed (p = .001). CONCLUSION: Generally, volume, compliance, and pressure values declined significantly in rabbits in which the bulla had been filled with fluid when compared with rabbits with empty bullae. Drilling a hole into the bulla increased volumetric values under normal conditions but had no effect on compliance and pressure values. The significant difference between groups 3 and 6 regarding pressure demonstrates that the density of fluid in the middle ear plays a role in pressure values when measured with tympanometry. We conclude that the correlation between density and pressure values of middle ear fluids may be useful in the clinical decision-making process when treating disorders such as otitis media.

Reversed ipsilateral acoustic reflex pattern.

OBJECTIVE: To determine the characteristics and possible origin of reversed ipsilateral acoustic reflex. STUDY DESIGN: Retrospective. SETTING: University hospital. PATIENTS: Sixty-three ears in 52 patients (mean age 37.6 years) with unilateral or bilateral sensorineural hearing loss and 45 age- and sex-matched persons as controls. METHODS: Audiometry and impedance audiometry examinations were studied retrospectively. Hearing test records were investigated, and patients with unilateral or bilateral sensorineural hearing loss were included. Forty-five age- and sex-matched persons served as controls. The ipsilateral and contralateral acoustic reflex patterns of these patients were investigated. Reflex-forming acoustic thresholds and latencies of ipsilateral reversed (positive) reflexes were compared with ipsilateral negative (upward) reflexes. RESULTS: The ipsilateral acoustic reflexes of 18 of 63 ears with sensorineural hearing loss were absent, and the remaining 45 were reversed (positive). A significant difference was found between ipsilateral reversed and ipsilateral negative acoustic reflex thresholds (p < .001) and latencies (p < .001). No statistically significant differences were found between ipsilateral and contralateral negative reflex latencies. CONCLUSIONS: The reversed acoustic reflex pattern is not an artifact but a physiologic event. This reflex does not appear to be related to stapedius or tensor tympani muscle contraction. We believe that the etiology of the reversed reflex is related to the system that contains the tympanic membrane, malleus, and incus and their ligaments but not the middle ear muscles.

Intratympanic methylprednisolone for sudden sensorineural hearing loss.

OBJECTIVE: Corticosteroids are commonly used for the treatment of sudden sensorineural hearing loss (SSHL). In this study, the effectiveness of intratympanic (IT) corticosteroid injection was studied and compared with a control group on patients with SSHL who failed systemic corticosteroid treatment. MATERIALS AND METHODS: A total of 19 patients as a retreatment group (RG) and 18 patients as a control group (CG), all failed high-dose intravenous and oral corticosteroid treatments, were included in this study. These patients were invited back, and IT methylprednisolone was injected five times via 3-day intervals in RG and followed-up for a mean period of 24.9 months (range, 7-30 mo). Audiological evaluations were performed initially, a week after the completion of the injections, monthly in the following first 3 months, and at the end of follow-up period in RG. The CG was followed-up for 3 months after the completion of systemic corticosteroid treatment without any additional drug administration. RESULTS: The mean age was 52.6 years (range, 20-79 yr) in RG and 59.9 years in CG. The mean pure-tone average for speech frequencies (500-4,000 Hz) at baseline audiogram and at the first month, at the third month, and at last controls were 65.2 (range, 43-102 dB), 45.4 (range, 23-77 dB), 43.6 (range, 30-77 dB), and 44.5 (range, 33-77 dB) dB, respectively, in RG. The mean pure-tone averages for speech frequencies (500-4,000 Hz) at the end of systemic treatment and at third-month control were 63.5 (range, 44-98 dB) and 59.0 (range, 40-100 dB) dB, respectively, in CG. The hearing gain that is equal to or more than 10 dB was achieved in 14 patients (73.6%) at the last control in RG. No hearing gain could be detected in the CG. No serious side effect was observed with IT treatment. CONCLUSION: We conclude that IT methylprednisolone injection provides more significant hearing improvement for patients that failed with previous high-dose systemic corticosteroid administration than systemic corticosteroid treatment alone. So it may be the first-step medical treatment of idiopathic SSHL alone or at least may be combined with the systemic corticosteroid administration.

Pre-emptive analgesia for removal of nasal packing: A double-blind placebo controlled study.

OBJECTIVE: The most frequent complaint of patients after septoplasty is severe pain felt during removal of nasal packing placed on the operation. Various methods have been described to decrease pain and to increase patient comfort during removal of nasal packing. However, these methods are not practical. There has been an increase in the number of studies on pre-emptive analgesia use for postoperative pain relief. The aim of this study was to determine whether pre-emptive analgesia decreased pain during removal of Merocel packs placed in septoplasties. METHODS: This is a double-blind randomized, placebo-controlled study. The study included 121 patients who underwent elective septoplasty in our otorhinolaryngology clinic. The patients were randomly assigned into two groups: study and placebo groups. The study and placebo groups received two tablets of diflunisal 500 mg and placebo, respectively, two and a half hours before removal of nasal packing. Visual analog scale (VAS) values immediately after and 5 min after removal of nasal packing, effects of the procedure on patient comfort and its side-effects were evaluated separately. RESULTS: VAS values immediately after the removal of nasal packs significantly decreased in the study group (p<0.001), but there was no significant difference in VAS values obtained after the procedure between the study and placebo groups. Patient discomforts were significantly lower in the diflunisal group (p<0.001). CONCLUSIONS: It can be concluded that pre-emptive analgesia decreases pain during removal of nasal packing placed in septoplasties and increases patient comfort.

Ganglioneuroma of the internal auditory canal: a case report.

Ganglioneuroma is a rare, benign, slow-growing tumor thought to develop from cells of neural crest origin, even though hypotheses on the pathogenesis of that lesion differ. Ganglioneuromas, which do not release excessive catecholamine or steroid hormones, develop primarily in the posterior mediastinum and retroperitoneum. Because of their slow growth, many ganglioneuromas are large when they are diagnosed. In this case report, a 50-year-old woman with hearing loss is described. Magnetic resonance imaging revealed a mass (3 x 4 mm) in the internal auditory canal (IAC). The encapsulated tumor was entirely excised via the middle fossa approach. The results of histopathological examination indicated that the excised lesion was a ganglioneuroma. To our knowledge, this is the first report of a ganglioneuroma of the IAC. We suggest that ganglioneuroma be considered in the differential diagnosis of all tumors of the IAC.