Effect of surgical intervention on middle-ear cholesteatoma with associated facial paralysis.

OBJECTIVES: To investigate the presenting symptoms, intra-operative findings and long-term facial nerve function in patients treated for cholesteatoma with associated facial paralysis. METHODS: Fifteen patients with facial paralysis due to middle-ear cholesteatoma who underwent tympanomastoidectomy surgery from February 2000 to February 2015 were retrospectively reviewed. After removal of the cholesteatoma, a limited area of the fallopian canal, in which facial nerve oedema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed. RESULTS: Pre-operative House-Brackmann grade was grade II in two patients, grade III in four, grade IV in seven, grade V in one and grade VI in one. Facial nerve perineurium damage was observed in two patients with poor prognoses. All patients treated within the first 15 days after paralysis onset showed normal facial function at long-term follow up. Post-operative House-Brackmann grade was grade I in 11 patients, grade II in 1, grade III in 2 and grade VI in 1. CONCLUSION: Early surgical treatment is more likely to give good results, and poor outcomes are observed in patients with facial nerve perineurium damage.

Prevention of gentamicin ototoxicity with N-acetylcysteine and vitamin A.

OBJECTIVE: To investigate the use of systemic N-acetylcysteine and vitamin A in the prevention of gentamicin ototoxicity in rats. METHODS: Forty-two Wistar rats were divided into four groups according to treatment: intratympanic saline, intratympanic gentamicin, intraperitoneal vitamin A after intratympanic gentamicin, and intraperitoneal N-acetylcysteine after intratympanic gentamicin. Signal-to-noise ratio and distortion product otoacoustic emissions were evaluated in all groups. RESULTS: N-acetylcysteine had a significant protective effect at 1.5, 2, 3, 4, 6 and 8 kHz, whilst vitamin A had a significant protective effect at 2, 3, 4 and 6 kHz, as determined by the distortion product otoacoustic emission measurements. According to the signal-to-noise measurements, N-acetylcysteine had a significant protective effect at 1.5, 2, 3, 4, 6 and 8 kHz, whilst vitamin A had a significant protective effect at 3, 6 and 8 kHz. CONCLUSION: Gentamicin-induced hearing loss in rats may be prevented by the concomitant use of vitamin A and N-acetylcysteine. Specifically, N-acetylcysteine appeared to have a more protective effect than vitamin A for a greater range of noise frequencies.

Early stage squamous cell carcinoma of the lower lip: predictive factors for recurrence.

OBJECTIVE: This study aimed to evaluate the effect of tumour thickness on other clinicopathological parameters in early stage lower lip squamous cell carcinoma. METHODS: Forty-six consecutive patients with lower lip squamous cell carcinoma were included in the study. Demographic, clinical and pathological data were retrospectively collected. RESULTS: The mean follow-up period for all patients was 32.0 ± 18.9 months. Forty-four tumours were staged as T1 and two were T2. Twelve patients underwent neck dissection. Two patients presented with neck metastasis in the follow-up period. Four patients (8.7 per cent) had local recurrence. Correlation analysis revealed a significant relationship between microscopic tumour thickness and local tumour recurrence (r = 0.328, p = 0.045). CONCLUSION: Surgical margin control is important to prevent local recurrence, especially in thicker tumours. In addition, neck metastasis is rare in early stage lower lip squamous cell carcinoma. A 'wait and see' policy might be preferred in early stage T1 lower lip squamous cell carcinoma cases.

Outcomes with gold wire and hydroxyapatite partial ossicular replacement prostheses in type 2 tympanoplasty: a preliminary study.

OBJECTIVES: To compare the hearing results and graft take rates of the recently developed gold wire prosthesis with those of the hydroxyapatite partial ossicular replacement prosthesis in patients with chronic otitis media. METHOD: This retrospective study examined patients who underwent type 2 tympanoplasty with a minimum follow up of one year. The study population consisted of 32 patients in the partial ossicular replacement prosthesis group and 26 patients in the gold wire group. The main outcome measures were the graft success rate and level of hearing improvement. Complications and extrusion rates were also noted. RESULTS: The graft take rate was 90.6 per cent for the partial ossicular replacement prosthesis group and 92.3 per cent for the gold wire group (p = 0.848). Pre-operatively, there were no significant differences in the air or bone-conduction thresholds between groups. Post-operatively, the mean hearing gain was 18.5 ± 14.0 dB in the partial ossicular replacement prosthesis group and 16.5 ± 10.6 dB in the gold wire group (p = 0.555). The mean air-conduction thresholds were 26.6 ± 12.4 and 32.6 ± 10.5 dB, respectively (p = 0.027), and the mean bone-conduction thresholds were 9.7 ± 7.0 and 10.4 ± 6.4 dB, respectively (p = 0.687). CONCLUSION: The success and complication rates provided by the gold wire prosthesis seem comparable to those of the hydroxyapatite partial ossicular replacement prosthesis.

Long-term psychosocial impact of otoplasty performed on children with prominent ears.

OBJECTIVES: To investigate the psychosocial impact of prominent ears on children, and evaluate the outcomes of otoplasty two years after surgery, using the Child Behavior Checklist to comparatively evaluate patients' psychosocial profiles. METHOD AND RESULTS: A total of 198 otoplasty procedures were performed in 107 patients (85 per cent bilateral procedures). Otoplasty was performed solely in 86 patients and concurrently with other procedures in 21 patients. All children who underwent surgery obtained good post-operative results, with satisfactory correction of the deformity reported by the patients and their parents or guardians. There were statistically significant decreases in Child Behavior Checklist scores in the domains of: anxiety and depression (p = 0.028), social problems (p = 0.018), difficulties in thinking (p = 0.012), total behavioural problems (p = 0.012), internalising problems (p = 0.020) and externalising problems (p = 0.044), and near-significant decreases in scores for attention problems (p = 0.055) and aggressive behaviour (p = 0.078). There was a statistically significant increase in the score for total social competence (p = 0.031). CONCLUSION: Psychological problems associated with anatomical deformities such as prominent ears can be reduced by means of appropriate corrective surgery. Psychological support is necessary for the patient.

An unusual location for a fungus ball: the concha bullosa.

OBJECTIVE: We report an unusual case of a fungus ball in the concha bullosa, without involvement of the paranasal sinuses. CASE REPORT: A 29-year-old woman presented complaining of nasal obstruction and postnasal discharge. Paranasal computed tomography demonstrated that the concha bullosa in the right middle turbinate was filled with a high-density material. The patient underwent endoscopic resection of the concha bullosa, during which a dark brown, cheese-like material was found. Histopathological examination of the excised specimen revealed a fungus ball. CONCLUSION: Fungus balls are non-invasive accumulations of dense fungal concretions that generally affect healthy individuals. In the sinonasal region, they occur most frequently in the maxillary sinus. Although fungus ball formation in the concha bullosa is unusual, it should be considered in the differential diagnoses of middle turbinate and sinonasal pathology.

Functional results of temporalis fascia versus cartilage tympanoplasty in patients with bilateral chronic otitis media.

OBJECTIVES: To compare the functional results of type I tympanoplasty performed with either temporalis fascia or a perichondrium and cartilage island flap, in patients with bilateral chronic otitis media. METHOD: The study included primary tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least one month and normal middle-ear mucosa, together with contralateral tympanic membrane perforation. Temporalis fascia tympanoplasty was undertaken in 41 patients, and cartilage tympanoplasty in 39 patients. RESULTS: The graft success rate was 65.9 per cent for the fascia group and 92.3 per cent for the cartilage group. Post-operatively, the mean ± standard deviation air conduction threshold was 28.54 ± 14.20 dB for the fascia group and 22.97 ± 8.37 dB for the cartilage group, while the mean ± standard deviation bone conduction threshold was 11.71 ± 8.50 dB for the fascia group and 7.15 ± 5.56 dB for the cartilage group. CONCLUSION: In patients with bilateral chronic otitis media, cartilage tympanoplasty seems to provide better hearing results and graft success rates.

Bilateral deep neck space infection in the paediatric age group: a case report and review of the literature.

Deep neck space infections can occur at any age but require more intimate management in the paediatric age group because of their rapidly progressive nature. Concurrent abscess in distinct neck spaces has rarely been reported in healthy children. Herewith, a rare case of bilateral neck abscess is reported in a 16-month-old female and the clinical presentation and management are discussed with a review of the literature.

Effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray on clinical signs and quality of life of patients with streptococcal tonsillopharyngitis: multicentre, prospective, randomised, double-blinded, placebo-controlled study.

OBJECTIVE: To assess the effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray, used in conjunction with antibiotic treatment, on the intensity of clinical signs and quality of life of patients with group A streptococcal tonsillopharyngitis. METHODS: Patients (n = 147) with streptococcal tonsillopharyngitis were recruited and randomly allocated to either the treatment group (penicillin plus chlorhexidine and benzydamine; n = 72) or control group (penicillin plus placebo; n = 75). Blinded assessments were conducted before and after 10 days' treatment, using an intensity rating scale for clinical sign severity, a visual analogue scale for subjective health state, the Short Form 36 Health Questionnaire for quality of life, and a customised questionnaire for side effects. RESULTS: The treatment group showed a statistically significant reduction in the intensity of clinical signs, compared with the control group. On treatment day 7, there was no significant difference in quality of life between the treatment and control groups. The treatment drugs were well tolerated, and no serious adverse events were observed. CONCLUSION: Chlorhexidine gluconate and benzydamine hydrochloride mouth spray, added to standard antibiotic treatment, significantly alleviate the intensity of clinical signs in patients with streptococcal pharyngitis. Further research is needed using larger sample sizes or alternative control groups.

Otologic surgery in HIV-infected patients.

As the lifespan of patients with HIV continues to increase secondary to improvements in antiretroviral medications, patients can keep the virus in a latent state for a longer period of time than ever before. As a result, patients live longer with infection and demand a higher quality of life during the course of the disease. The most important decision in the management of otologic manifestations of AIDS is whether the patient should be operated. The surgery of HIV-infected patients includes two important issues: Risk of transmission of HIV to health care workers and delay of wound healing. In this paper we describe the three otologic procedures of two HIV-infected patients managed successfully without complication. We, like many others, believe that otolaryngologists should apply strict surgical criteria to HIV-infected patients for otologic procedures and should not withhold rational therapy because of the patient's HIV status.

Frontal sinus osteoma complicated with intracranial inflammatory polyp: a case report and review of the literature.

BACKGROUND: Osteomas of the paranasal sinuses rarely cause intracranial manifestations. A neurological symptom may be the first sign of a previously unrecognized osteoma. CASE DESCRIPTION: A 28-year-old male was referred with one episode of witnessed tonic-clonic seizure and loss of consciousness. Radiologic examination revealed a calcific mass in the frontal sinus and a cystic structure was detected in the posterior component of the lesion. The patient underwent a combined nasal endoscopic approach and a bilateral frontal osteoplastic craniotomy. The ossifying tumoral tissue and the polypoid soft tissue mass were removed. The histo-pathologic diagnosis of the hard, bony tumor was consistent with an osteoma and the polypoid soft tissue was an inflammatory polyp. CONCLUSION: This case report illustrates a rare and life threatening complication of a frontal sinus osteoma with an intracranial extension of an inflammatory polyp.