Protective effect of creatine on amikacin-induced ototoxicity.

INTRODUCTION: Aminoglycosides are widely known for their ototoxic side effects. Nevertheless, they are potent antibiotics used in the treatment of life-threatening conditions because of the current concern for antibiotic resistance. We hypothesized that creatine supplements which are believed to improve mitochondrial antioxidant defense system and maintain optimal energy homeostasis may improve the ototoxic side effects. OBJECTIVE: This study aimed to investigate the protective effects of creatine monohydrate against ototoxicity induced by amikacin in rats in an experimental animal model, using distortion product otoacoustic emissions and auditory brainstem response. METHODS: Twenty healthy rats were assigned to four groups (5 rats in each): the control group, the creatine monohydrate group, the amikacin group and the amikacin+creatine monohydrate group. The creatine monohydrate group received creatine at a dose of 2g/kg once daily via gastric gavage for 21 days. The amikacin group received amikacin at a dose of 600mg/kg by intramuscular injections once daily for 21 days. The amikacin+creatine monohydrate group received intramuscular injections of amikacin (600mg/kg) once daily for 21 days and creatine monohydrate (2g/kg) once daily via gastric gavage for 21 days. The control group received nothing. The distortion product otoacoustic emissions and auditory brainstem response measurements were performed on all rats on days 0, 7, 21. RESULTS: Regarding auditory brainstem response values, a significant increase in the auditory threshold was observed in the amikacin group on day 21 (p< 0.001). The amikacin+creatine monohydrate group showed significantly lower levels of auditory brainstem response auditory thresholds on day 21 in comparison to the amikacin group (p< 0.001). Additionally, the control group and the amikacin+creatine monohydrate group did not differ significantly with respect to auditory brainstem response thresholds on treatment day 21 (p> 0.05). When we compare distortion product otoacoustic emissions values, there was no significant difference between the amikacin and amikacin+creatine monohydrate groups on day 7 (p> 0.05), However significantly greater distortion product otoacoustic emissions values were observed in the amikacin+creatine monohydrate group on day 21 compared to the amikacin group (p< 0.001). CONCLUSION: Our findings demonstrate that creatine treatment protects against amikacin ototoxicity when given at a sufficient dose and for an adequate time period.

A Novel Proposal for Classifying Pediatric Tonsillectomy Complications: Modified Clavien Classification.

Introduction Tonsillectomy is one of the most common operations performed in the otolaryngology practice and there does not exist a systematic classification for tonsillectomy complications in the prior literature. In this study, we aimed at presenting a novel classification system to the current literature and analyzing complications of pediatric tonsillectomy based on this novel classification system. Methods  A novel classification system based on modified Clavien classification was constituted for pediatric tonsillectomy complications. Medical records of 534 patients underwent tonsillectomy were retrospectively investigated and complication rates of tonsillectomy between children and adults were compared using this classification Results  In total, 454 pediatric patients (258 males and 196 females, age range = 3-17 years) who underwent cold-knife tonsillectomy were eligible for the study. To compare the complication rates of the pediatric patients with adults, 80 adults with tonsillectomy (50 males and 30 females, age range 18-46) were also included. In children, the most common complication was dehydration, seen in 13 (2.86%) patients. The most serious complication was tooth aspiration (Grade 4a), seen in only one (0.22%) patient. Fifteen (3.3%) pediatric patients experienced more than one complication. Overall complication rate of pediatric tonsillectomy was 10.13% (46 patients). In adults, the most common complication was postoperative bleeding, seen in 11 (13.75%) adult patients. The most serious complication was Grade 3a postoperative bleeding, seen in four (5%) patients. Overall complication rate of adult tonsillectomy was 21.25% (17 patients). Overall complication rate of pediatric tonsillectomy was significantly lower compared with the complication rate of adult tonsillectomy (10.13% vs. 21.25%, p = 0.004, X2 = 8.07). Conclusion  Modified Clavien classification is a novel and simple tool to analyze and categorize complications of pediatric tonsillectomy.

Lymph node yield and lymph node density for elective level II-IV neck dissections in laryngeal squamous cell carcinoma patients.

PURPOSE: To determine the minimum lymph node yield (LNY) in patients with laryngeal squamous cell carcinoma (LSCCs). METHODS: This retrospective study was performed in a tertiary care hospital setting and included 42 LSCC patients aged 39-81 years (females, n = 2; males, n = 40) who underwent a total or partial laryngectomy and elective bilateral level II-IV neck dissections (unilateral neck dissections: n = 84). RESULTS: The average LNY in the unilateral level II-IV lymph node dissections was 25.9 ± 10, and the average metastatic LNY was 0.9 ± 1.9. The unilateral neck dissections were grouped according to the number of lymph nodes. There was no significant difference between the groups in terms of the metastatic LNY (p = 0.5). The metastatic lymph node density (LND) (metastatic lymph node yield/LNY) was 0.043 for unilateral neck level II-IV neck dissections. A Cox regression analysis revealed no significant relationship between survival and the LNY and LND in bilateral neck dissections (p = 0.4 and p = 0.8, respectively). CONCLUSIONS: The results revealed no minimum number of lymph nodes that could reliably detect metastatic lymph nodes in LSCC patients.

Effects of early postoperative nasal decongestant on symptom relief after septoplasty.

BACKGROUND: A randomized, prospective, double-blinded clinical study was conducted at a single, tertiary referral center. The aim of the study was to evaluate the effects of nasal decongestant use in the early postoperative period after septoplasty. METHODS: After septoplasty, patients who met the study inclusion criteria were randomized into 2 groups to receive either physiologic saline irrigation (saline group) or physiologic saline irrigation plus oxymetazoline hydrochloride 0.05% nasal spray (saline+oxymetazoline group). Visual analog scale (VAS) scores for bleeding, pain, and nasal crusting; Nasal Obstruction Symptom Evaluation (NOSE) scores; and rhinomanometric measurements were assessed pre- and postoperatively. RESULTS: The VAS scores for bleeding and nasal crusting of patients in the saline+oxymetazoline group were significantly lower compared with the saline group (p < 0.005). VAS scores for pain were similar between the groups (p > 0.05). Total nasal resistance and NOSE scores of patients in the saline+oxymetazoline group were significantly lower than in saline group after surgery (p < 0.005). CONCLUSION: The use of nasal decongestant sprays in the very early postoperative period is beneficial to reduce the postsurgical nasal crusting and bleeding symptoms and also for decreasing nasal resistance in this edematous period.

A Noteworthy Pathology in Children with Learning Disabilities: Late Latency Response Failure in Central Auditory Processing.

OBJECTIVES: This study investigates the cortical auditory pathways in children with and without learning disability (LD). MATERIALS AND METHODS: A prospective, controlled clinical study was conducted on patients diagnosed with LD and was followed-up for a minimum period of 6 months in the Department of Child and Adolescent Psychiatry were included as study group. The control group comprised of age- and gender-matched healthy individuals. After otolaryngological and psychiatric examination, all participants were tested using pure-tone audiometry, tympanometry, acoustic reflex, and cortical auditory evoked potentials. Test results were evaluated and compared for each group. RESULTS: The study included a total of 60 children (30 children with LD as study group and 30 healthy children as control group) who met the inclusion criteria. When event-related potentials were taken into consideration, P2 and P300 mean amplitudes for right ears and N1 and P300 mean amplitudes for left ears were significantly lower in study group than those in the control group. Likewise, P2 and P300 mean latency in right ears and P1, N1, and P300 mean latency in left ears were prolonged in study group (p<0.05). CONCLUSION: Patients with LD may have disorders of the cortical auditory processing even if they have normal hearing screening tests. Pathologies in late-latency evoked potentials may have a role in the etiology of these patients.

Hearing outcomes after suppurative chronic otitis media surgery.

OBJECTIVES: This study aims to compare the hearing outcomes after canal wall up mastoidectomy (CWUM) and canal wall down mastoidectomy (CWDM). PATIENTS AND METHODS: Ninety-two patients (74 males, 18 females; mean age 30.1 years; range 9 to 67 years) who were diagnosed with chronic suppurative otitis media (CSOM) between January 2009 and May 2011 were enrolled in this retrospective study. Based on hospital data, patients were separated into two groups as having mucosal or squamous disease. Patients were also categorized into two groups based on the type of mastoidectomy: CWUM (n=51) and CWDM (n=41). Hearing results between the groups were evaluated using the air-bone gap (ABG) recorded by audiogram before surgery and at three months after ossiculoplasty. Relationship between obtained hearing results and performed ossiculoplasty techniques were also discussed. RESULTS: We were able to perform ossiculoplasty in 42.3% (n=39) of patients diagnosed with CSOM. Presurgical ABG in CWUM and CWDM groups were 35.38±10.82 dB and 37.92±5.80 dB, respectively. Postsurgical ABG value was ≤20 dB in 27% of CWUM patients and 7.7% of CWDM patients. Mean hearing gain of patients with active squamous disease was 3.8 dB in CWUM group and 11.9 dB in CWDM group (p<0.5). CONCLUSION: The pathology affecting the middle ear had influence on the hearing results of the two groups. Canal wall down mastoidectomy may be a beneficial procedure to improve hearing in patients with CSOM.

Assessment of nasal mucociliary clearance in anesthetists.

BACKGROUND/AIM: To assess mucociliary clearance in anesthetists who were exposed to waste anesthetic gases occupationally. MATERIALS AND METHODS: The first group consisted of 30 anesthetists who had been working at least 2 years. The control group of 30 subjects was selected from hospital staff with no history of occupational exposure to waste anesthetic gases. Mucociliary clearance time was assessed by measuring the saccharine nasal transit time (SNTT). RESULTS: Thirty-six women and 24 men aged between 25 and 60 years were enrolled in the study. There were no differences between the anesthetist and control groups in terms of age, sex, height, or weight. The median SNTT for the anesthetists (10 min) was longer than that for the control group (8.3 min). The difference was significant (P = 0.025). In addition, there was a significant correlation between the SNTT and the working time (P = 0.02). Furthermore, anesthetists who had worked for 4 years or more had prolonged SNTT compared to those who had worked less than 4 years (P < 0.001). CONCLUSION: The present study demonstrated the impairment of mucociliary clearance in anesthetists. Increasing impairment with increasing working time was also detected.

Vestibular functions were found to be impaired in patients with moderate-to-severe obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: Obstructive sleep apnea (OSA) and balance disorders are common chronic diseases seen in the general population. The aim of this study was to evaluate vestibular functions in individuals with OSA. STUDY DESIGN: Cross-sectional clinical study. METHODS: Patients who were referred to the sleep clinic in our hospital were classified into two groups according to a polysomnographic test: a moderate-to-severe OSA group and a mild OSA group. A vestibular system assessment of all patients was performed subjectively with the Dizziness Handicap Inventory (DHI) survey and objectively with videonystagmography. RESULTS: The current investigation produced four major findings: 1) Apnea-hypopnea index was significantly correlated with age and body mass index, whereas it was not correlated with Epworth Sleepiness Scale scores. 2) There was a significant difference in study groups in terms DHI scores, particularly in the physical subgroup. Moderate-to-severe OSA patients had higher scores in the physical subgroup of DHI. 3) Nystagmus and canal paresis rates were significantly higher in the moderate-to-severe OSA group when compared to the mild OSA group. 4) Results of the Romberg test, tandem Romberg test, cerebellar examinations, and positional tests were normal in both. CONCLUSIONS: Abnormal vestibular responses are common in individuals suffering from severe OSA, and dizziness has negative effects on the quality of life in these individuals. LEVEL OF EVIDENCE: 4

Surgical approach and outcomes for revision surgery of the central neck compartment.

Revision surgery of the central neck compartment is still a controversial subject, and data are scarce in the literature regarding surgical approaches and outcomes. This might be a result of the small number of patients in need of revision of the central neck compartment. Therefore, the purpose of this study was to document the approach and outcomes for revision surgery of the central neck compartment performed in our clinic. The files of patients who had undergone revision surgery of the central neck compartment in the Clinic of Otorhinolaryngology, Ankara Numune Training and Research Hospital, between 2007 and 2013, were evaluated. The subjects included 61 patients who had previously undergone surgical intervention in the central neck compartment and had then undergone bilateral lymph node dissection covering at least levels 6 and 7 in our clinic. Patient ages ranged between 36 and 63 years (mean, 47.2 y; SD = 8.3 y). The complications seen after revision surgery were temporary recurrent laryngeal nerve palsy in 4 patients (6.6%), temporary hypocalcemia in 8 patients (13.1%), and permanent hypocalcemia in 3 patients (4.9%). No permanent recurrent laryngeal nerve damage, wound infection, or hematoma was encountered. Meticulous surgical dissection with identification of the recurrent laryngeal nerve and the implantation site of the parathyroid glands may safeguard against complications. Reoperative surgery in the central compartment of the neck allows the removal of recurrent/persistent disease and has acceptable morbidity.

Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications.

CONCLUSION: The patients who underwent septoplasty with bilateral totally occlusive nasal packing had an increased risk of experiencing respiratory distress (RD). OBJECTIVE: To compare the immediate RD rates during recovery from anesthesia and surgical complications of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique. METHODS: A total of 150 patients were assigned to one of three groups according to the technique utilized following septoplasty: transseptal suturing, internal nasal splint, or Merocel (nasal dressing without airway). To determine RD related to anesthesia in the operating theatre, the criterion was defined as any unanticipated hypoxemia, hypoventilation or upper airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. Postoperative hemorrhage, infection, synechia formation, and septal perforation were evaluated. RESULTS: Patients in the Merocel group were 3.6 times more likely to have RD than patients in the transseptal suture and internal nasal splint groups. Also, patients who smoked had an increased risk of RD during the recovery phase of anesthesia after the septoplasty. In addition, all three techniques resulted in similar complication rates after septoplasty, with the exception of minor hemorrhage, which had a significantly higher rate in the transseptal suture group.

Changes in Acoustic Parameters of Voice After Endoscopic Sinus Surgery in Patients with Nasal Polyposis.

Our aim was to evaluate acoustic voice analysis of patients diagnosed with nasal polyps before and after endoscopic sinus surgery. Forty-three patients diagnosed with nasal polyposis who had undergone endoscopic sinus surgery were included in this prospective study. Patients were divided into three groups according to the stage of nasal obstruction before the surgery. Acoustic voice analyses were performed on each patient before the endoscopic sinus surgery and six weeks following the surgery with the multi-dimensional voice program. Jitter, shimmer, F0 frequency, and noise to harmonic ratio (NHR) parameters were obtained for acoustic analysis. Our investigation showed that Jitter, shimmer and NHR values decreased, and F0 value increased in the postoperative period in patients that had a partial nasal obstruction before the surgery. Non-significant increases were also observed in these four parameters after the surgery in cases with total or near-total nasal obstruction. We also found that the postoperative changes in shimmer values between the Stage III patients and the patients in other stages were statistically significant (P = 0.027). Voice changes that became more marked with increasing stages of the nasal polyposis. According to our results, patients should be informed of the possible alterations in speech following major surgical interventions on the paranasal sinuses.

[Unusual distant metastasis of larynx carcinoma: a case report]. / Larenks kanserinde sik görülmeyen uzak metastaz: Olgu sunumu.

Although distant metastasis from larynx carcinoma is more common in the late stages, it may sometimes occur in the initial period of the disease. The tumor spread may be by a lymphatic or nonlymphatic route. A 40-year-old male patient presented with complaints of hoarseness and shortness of breath. Indirect laryngoscopic examination showed a vegetable mass extending from the left laryngeal side of the epiglottis to the left vocal cord. Level 3 lymphadenopathies were noted in the jugular region. Biopsy result revealed epidermoid carcinoma. Magnetic resonance imaging performed due to complaints of back pain and foot numbness demonstrated aggressive spinal cord metastases. The patient died on the tenth day of hospitalization.

Lipoid proteinosis of larynx: review of four cases.

Lipoid proteinosis is a rare autosomal recessive disorder characterized by intercellular deposition of an amorphous hyaline material. It mainly involves skin and mucosal membranes of upper aerodigestive tract as well as central nervous system, lung, lymph nodes and striated muscles. Etiology and pathogenesis are unknown. Infantile hoarseness is a common presenting feature of the disease due to infiltration of larynx. In two-thirds of the cases, voice changes are present at birth or in early infancy as the first manifestation. We present four patients with lipoid proteinosis involving skin, oropharynx and larynx.

Collagenous fibroma (desmoplastic fibroblastoma).

A Collagenous Fibroma (Desmoplastic Fibroblastoma) is a rare, benign, slowly growing, fibroblastic, soft tissue lesion. Here, the case of a 28-year-old woman, who presented with a 1-year history of a slowly growing painless mass in the right anterior aspect of her neck, is described. This type of tumor was first described by Evans in 1995, and named as a Desmoplastic fibroblastoma but was renamed, by Nielsen in 1996 as a Collagenous Fibroma. This type of tumor is frequently reported in men with a mean age at occurance of 50 years. Clinically, a Collagenous fibroma presents as a firm, well-circumscribed subcutaneous, or intramuscular, painless mass of long duration. They are mostly located in the neck and extremities. The tumors range in size from 1 to 20 cm and predominantly occurs within the subcutaneous tissue, but fascial and skeletal muscle involvement is common. The treatment of a Collagenous Fibroma is a total surgical excision. No tumor recurrence has been reported the literature during the follow-up period and no tumor recurrence was observed in our case at the 1-year follow-up.

Role of free radicals and antioxidants in nasal polyps.

OBJECTIVES/HYPOTHESIS: The aim of this study is to determine the role of free radicals and antioxidants in nasal polyps. STUDY DESIGN: Prospective, randomized, controlled study. METHODS: Thirty-one patients with nasal polyposis and a control group consisting of 19 patients with septal deviation and lower turbinate hypertrophy were included in the study. Levels of the antioxidants retinol, beta-carotene, alpha-tocopherol, and ascorbic acid were measured from the sera of the patients with nasal polyposis and the control group. Plasma levels of superoxide dismutase activity (SOD), glutathione peroxidase (GSHPX) activity, and reduced glutathione (GSH) were also obtained. As a peroxidation product, the levels of the malondialdehyde-thiobarbituric acid (MDA) combination were measured from the plasma of patient and control groups. Measurements of MDA, GSH, and alpha-tocopherol levels were also taken from the polyp tissue and turbinate mucosa of the control group. RESULTS: The blood levels of antioxidants and MDA as an oxidant were significantly different in the patient group compared with the control group (P <.01). The tissue levels of antioxidants and MDA were significantly different in the patients with polyposis compared with the control group (P <.01). The blood and tissue anti-oxidant levels were found to be decreased, and MDA levels as an oxidant increased significantly in the patient group with polyposis when compared with the control group, and there was a negative correlation between oxidative stress and antioxidants. CONCLUSION: This study demonstrates that oxidative stress and tissue and blood antioxidants in the patients with polyposis were significantly different compared with the control group. The blood and tissue antioxidant levels decreased, and MDA levels, as an oxidant, increased significantly in the patient group with polyposis when compared with the control group. The current study demonstrates that there is strong evidence related to oxidative stress in the pathogenesis of nasal polyposis, and antioxidants can have a preventive role in free-radical-mediated tissue damage in nasal polyposis.

The role of 70-degree telescopic examination during direct laryngoscopic evaluation of laryngeal cancers.

Endoscopy has currently been an indispensable method in many areas of otorhinolaryngology, especially in paranasal sinus surgery. Telescopic evaluation of the larynx has not drawn much attention. In this study, a 70-degree angled rigid telescope was used along with computerized tomography (CT), indirect and direct laryngoscopy in the evaluation of laryngeal cancer. The critical areas such as the anterior commissure, subglottic region and ventricles were investigated specifically. Nineteen patients were collected in the study. We found the sensitivity for indirect laryngoscopy to be 20-25% and for direct laryngoscopy to be 50-70%. The scores for CT and 70-degree telescopy were 70-100%. In the subglottic region telescopy was superior to CT. We believe that, when it is used in association with CT, telescopy provides better insight when deciding between partial or total laryngectomy and a healthier evaluation of the resection margin.

Basaloid squamous cell carcinoma of the larynx.

Most of the malignancies arising from the upper respiratory system are squamous cell carcinomas (SCC). Basaloid squamous cell carcinoma (BSCC) is a rarely seen high grade variant of SCC that carries a poor prognosis. In this article, we present a case of BSCC of the larynx. In addition, we provide a review of the relevant literature along with a discussion of the differential diagnosis.