Analysis of lower airway inflammation in a rabbit model of acute rhinosinusitis.

This study aimed to investigate the association of inflammatory changes of upper and lower airways in a rabbit model of acute rhinosinusitis. The study included six adult albino rabbits. The sinuses of one animal were injected with saline solution and the animal was served as sham control. Other animals were implanted with intranasal S. aureus soaked-absorbable gelatin sponge. Acute rhinosinusitis was induced and subjects were sacrificed at the end of the second week. Tissue samples from all levels of the airway were obtained. They were evaluated for the presence of inflammatory changes histologically. A scoring system for airway inflammation was used for quantitative assessment of the degree of inflammation. Structural changes in the epithelial and stromal layers of the upper and lower airway structures were analyzed, as well. The animal of which the sinuses were injected with saline solution developed neither acute rhinosinusitis nor lower airway inflammation. In contrast, the animals in which acute rhinosinusitis was induced demonstrated significant upper and lower airway inflammation histologically. Inflammatory changes ranged from engorgement of blood vessels and polymorphonuclear cell proliferation within the capillaries, in the perivascular tissue of the epithelium or in the lamina propria and to epithelial disruption. Nasal airway inflammation scores (2.86 ± 1.81) were significantly higher than lower airway scores (1.36 ± 0.77), (P < 0.01). We obtained a generalized mucosal inflammatory response against localized bacterial inflammation in a rabbit model of acute rhinosinusitis, confirming the suggestion of 'one airway--one disease' from a bacterial infection point of view.

Comparison of the surface and core bacteria in tonsillar and adenoid tissue with Beta-lactamase production.

Adenoidectomy and tonsillectomy, indicated for children with recurrent or persistent symptoms of infection or hypertrophy, are among the most frequent operations performed in children. This study was carried out for investigating the microbial flora of the tonsils and adenoids regarding to core and surface microorganisms and also pathogen microrganisms' beta-lactamase production rate. Cultures were taken from the core and surface of tonsils and adenoids of the 91 patients at the time of the surgery for tonsillectomy and adenoidectomy. Aerobic and anaerobic cultures were inoculated and identified. Beta-lactamase production was detected also. The most frequently isolated aerobic microorganisms were Streptococcus viridans and Neisseria spp. The number of the microorganisms isolated from the tonsil core compared to the surface of the tonsils was found statistically insignificant (P > 0.05). The number of the adenoid surface aerobic microorganisms was found higher from the adenoid core (P < 0.05). The amount of adenoid and tonsil core anaerobic microorganisms were alike. The patients' preoperative antibiotherapy whether using beta-lactam or beta-lactamase resistant were compared for beta-lactamase producing bacteria production and the number of beta-lactamase producing bacteria were found statistically insignificant (P > 0.05). The togetherness of Staphylococcus aureus and other beta-lactamase producing bacteria was found statistically significant (P < 0.05). This study demonstrates that there is polymicrobial aerobic-anaerobic flora in both adenoids and tonsils. There was a close relationship between the bacteriology of the tonsil and adenoid flora. Staphylococcus aureus and and other beta-lactamase producing bacteria may be responsible for treatment failures in patients with tonsillitis.

Comparison of Histopathological and CT Findings in Experimental Rabbit Sinusitis.

The aim of this study was to investigate and compare histopathological and computerized tomographic (CT) findings of experimental acute sinusitis in an animal model. The noses of five healthy rabbits were inoculated with a gelatin sponge impregnated with a solution containing Staphylococcus aureus, and one healthy rabbit acted as the control. The animals were sacrificed on the tenth day, following the acquisition of paranasal CT scans. Specimens were obtained from the lateral nasal walls, and the ethmoid and maxillary sinuses of the animals for histopathological examination. Histopathological and CT findings were compared. Various degrees of epithelial disorganization, foci of ruptured epithelial cells, and inflammatory cell infiltration in the lamina propria were seen in the histopathological examinations of the five study rabbits, and mucosal thickening and soft tissue density were noted in their CTs. There was no correlation between the histopathological and CT findings. It was shown that CT did not reflect the acute changes in the sinus mucosa. Patients with chronic sinusitis must be evaluated for a chronic process. Computerized tomographic scans should not be obtained in acute sinusitis cases. In this way, both unnecessary radiation exposure and economic waste can be avoided.

[Revision surgery for chronic otitis media: evaluation of indications and results]. / Kronik otitis media düzeltme ameliyatlari: Endikasyon ve sonuçlarinin degerlendirilmesi.

OBJECTIVES: In patients who underwent primary and revision surgery for chronic otitis media, the types of revision surgery, most frequently observed regions of cholesteatoma, hearing results and the status of graft membrane were evaluated. PATIENTS AND METHODS: Forty-three of 495 patients (21 males, 22 females; mean age 38.4+/-15.2 years; range 15 to 76 years) with chronic otitis media who underwent revision surgery in our clinic between May 2003 and March 2009 were evaluated retrospectively. Indications for revision surgery were recurrence of the disease in 32 patients (74.4%) and reconstruction of hearing in 11 patients (25.6%). Forty patients (93.0%) underwent revision surgery once and three patients (7.0%) underwent revision twice. Over an average of 3.2 (range 1 to 6) years follow-up after primary and revision surgery, the types of revision surgery, the most frequently observed regions of cholesteatoma, hearing results and the status of graft membrane were assessed. RESULTS: Recurrence of cholesteatoma in revision surgery was seen in 28 patients (65.1%). Out of 27 patients, 23 patients (85.1%) showed intact graft membranes and four patients (14.8%) showed perforated graft membranes. CONCLUSION: In revision surgery, the first goal is to eliminate the disease. The management of chronic otitis media with cholesteatoma is surgery. Because of high postoperative recurrence rates, long-term follow-up is necessary.

Tinnitus after cochlear implantation.

OBJECTIVE: The purpose of this study was to investigate properties of tinnitus which starts after cochlear implantation. Of the 17 adult patients in our cochlear implant group, four (23.5%) who had no pre-implantation tinnitus were eligible for the study. METHODS: Each patient was requested to complete a short questionnaire regarding his or her experience with tinnitus. Tinnitus match test was performed for each patient by using an Interacoustic Clinical Audiometer (model AC40; Assens, Denmark). RESULTS: Tinnitus match test revealed a tinnitus frequency of a 4KHz for three and of a 6KHz for one patient. Mean value of the loudness score was calculated as 17.5dB SL. CONCLUSIONS: The results of this study emphasize the importance of counseling patients regarding risks of tinnitus after cochlear implantation.

Activation of vocal fold healing with topical vitamin A in rabbits.

CONCLUSION: The results suggest that vitamin A can prevent scar formation in the vocal fold after surgery. OBJECTIVES: This study aimed to evaluate the effects of topically applied vitamin A on healing after vocal fold trauma. MATERIALS AND METHODS: Vocal folds of 20 adult rabbits were traumatized unilaterally. Ten of them were treated with topical application of vitamin A and the others served as controls. All animals were sacrificed after 10 days. Vocal folds were resected for analysis by light microscopy. RESULTS: The untreated vocal folds showed extensive deposition of collagen and fibroblast on light microscopy and vocal folds treated with vitamin A showed less deposition. There was a significant difference between the two groups according to the percentage of collagen and fibroblasts in the lamina propria (p<0.01).

Continuous or intermittent noise exposure, does it cause vestibular damage? An experimental study.

OBJECTIVE: Aim of this study was to compare vestibular changes in guinea pigs exposed to same level of continuous and intermittent noise by electron microscopy. METHODS: The study included 10 adult albino guinea pigs. In a silent room, a 4-kHz octave band noise at an intensity of 120 dB SPL was presented. Six animals were exposed to continuous noise for 6h, and four animals were exposed to 12h intermittent noise. One day after noise exposure eight guinea pigs were decapitated and temporal bones of one side were removed. Ten days after continuous noise exposure two guinea pigs were decapitated. They were examined with an electron microscope. RESULTS: The most characteristic changes in the macula of the continuous noise exposure group were degeneration of the epithelial cells and separation in their layers. Marked crystolysis and stromal cell apoptosis were also noted in this group compared to the intermittent noise exposure group. Effect of noise was more obvious in the group that continuous noise was applied. The histological changes in group which examined after 10 days were similar to the group that examined after 1 day. CONCLUSION: Continuous noise can cause more damage to the vestibular system compared with intermittent noise and histological changes after continuous noise are permanent.

Anatomical variations of nasal turbinates.

After the widespread use of endoscopic sinus surgery and paranasal sinus computed tomography, many variations of nasal turbinates have been described. In addition to the most common one-middle turbinate pneumatization (concha bullosa)-superior and inferior turbinate pneumatizations have also been described. Secondary and accessory middle turbinates that can mimic real middle turbinate are anomalies described in recent years. Paradoxical middle turbinate and bifid inferior turbinate are very rarely encountered anomalies and can be easily recognized in paranasal tomography but can be overlooked by endoscopical examination. In the present study, the computed tomography images of 384 patients were evaluated for nasal turbinate variations, as well as their relations to mucosal pathologies. The most frequent variation was found to be concha bullosa; the least frequent one was found to be bifid inferior turbinate. In 1 of our patients, 5 of the 6 turbinates were found to have pneumatization, which is extremely rarely encountered in the literature. In this study, the prevalence of the variations of the turbinates and their association with chronic rhinosinusitis were investigated.

[Reliability and validity of the Turkish version of the Voice Handicap Index]. / Ses Handikap Endeksi (Voice Handicap Index) Türkçe versiyonunun güvenilirligi ve geçerliligi.

OBJECTIVES: We investigated the reliability and validity of the Turkish version of the Voice Handicap Index (VHI), and developed a short VHI form that would be more practical. PATIENTS AND METHODS: The original VHI was translated to Turkish by 10 otolaryngologists, then it was translated back to English by a linguist, and the final text was prepared by the evaluation committee composed of three members. The translated version was administered to a group of 220 subjects twice with 7-14 days intervals. Based on the responses, statistical analyses were performed to assess its reliability and validity. RESULTS: Internal consistency reliability was found to be highly significant (Cronbach's alpha=0.97). Test-retest correlation coefficient was 0.93 for the total score. Factor analysis yielded three factors explaining 64.8% of the total variance. The corrected item-total correlation coefficients ranged from 0.50 to 0.80. The 10 most robust VHI items, namely, E7, E9, P10, F11, F12, E15, F16, P18, P20 and E29, were selected using the corrected item-total correlation coefficients, and a shortened form of the Turkish VHI was developed. CONCLUSION: As some items are thought to be contentious in the Turkish VHI, the short form of the Turkish VHI is more suitable for use in clinics.

Sensorineural hearing loss after radiotherapy for head and neck tumors: a prospective study of the effect of radiation.

INTRODUCTION: In the treatment of head and neck cancers, the cochlea may be damaged if it is within the radiotherapy (RT) area; however, the severity and mechanism of such damage have yet to be clearly defined. The purpose of this study was to analyze the rates of early- and late-stage sensorineural hearing loss (SNHL) in patients receiving RT due to head and neck cancer and to investigate the reliability of distortion product otoacoustic emissions (DPOAEs) measurements and audiometric evaluation. STUDY DESIGN: Prospective. METHOD: The study included 38 ears of 19 patients scheduled for RT due to head and neck cancer diagnoses. The patients received RT at a fractioned dose of 200 cGy (5 d/wk) and were evaluated pretreatment and posttreatment (1st and 12th mo), both audiometrically and with DPOAE measurement. Any decrease greater than 10 dB was considered SNHL. The amplitudes of DPOAE measurements were statistically compared. RESULTS: The audiometric evaluation performed in the 1st posttreatment month showed no SNHL in any of the patients, whereas in the 12th month, 47% of the ears had SNHL. In all the patients that developed SNHL, the amplitudes obtained in DPOAE measurements in the first posttreatment month were statistically significantly lower. CONCLUSION: The results of the present study show that DPOAE measurement is a reliable method for determining which patients are at risk of developing SNHL in the early post-RT period.

Auditory brainstem response and otoacoustic emissions in Duane retraction syndrome.

OBJECTIVE: We aimed to investigate the origin of hearing loss with relevance to auditory brainstem responses and otoacoustic emissions in patients with Duane's retraction syndrome (DRS). MATERIALS AND METHODS: 17 patients with DRS were included in the study. 14 patients were diagnosed as DRS type 1 and the remaining three as type 3. The control group consisted of nine healthy subjects. Pure tone audiogram, auditory brainstem response, as well as distortion product otoacoustic emissions were recorded in all the patients and the controls. RESULTS: Among the 17 patients with DRS, 15 demonstrated normal hearing according to pure tone audiogram. One patient with DRS had profound sensorineural hearing loss with a pure tone average of 110 dB, and one patient had moderate sensorineural hearing loss with a pure tone average of 60 dB. Auditory brainstem response latencies of the waves I, III and V, and interwave latencies were calculated in 15 patients with DRS and were compared with the control group. There was statistically significant increase in wave I latency of left ear in the DRS group compared to the controls (P<0.05). Amplitudes of distortion product otoacoustic emissions were also recorded at frequencies of 2, 3, 4, 6, and 8 kHz in both groups and the comparison of the DRS patients and controls revealed no statistically significant difference. CONCLUSIONS: We recommend auditory examinations be undertaken in patients with DRS by auditory brainstem response tests, as well as distortion product otoacoustic emissions, whereas all patients with normal results should be followed-up for future hearing loss.

The effect of topical doxycycline in the prevention of experimental tympanosclerosis.

OBJECTIVES: The aim of this study is to determine the effectiveness of topical doxycycline used in the process of experimental myringosclerosis and tympanosclerosis. STUDY DESIGN: A prospective experimental animal study. METHODS: Experimental tympanosclerosis was accomplished in 25 healthy adult guinea pigs by inoculation with 2.5 x 10(7) colony-forming units of type-3 Streptococcus pneumoniae microorganisms followed by bilateral myringotomy. While the animals' right ears received a topical doxycycline treatment daily, their left ears were left untreated and used as controls. Otomicroscopic examination was carried out weekly and healing tympanic membranes were remyringotomized. After a 6-week follow-up, the temporal bones of 24 of 25 animals were removed and light-microscopy examination was done regarding tympanic membrane myringosclerosis and middle ear mucosal sclerosis. RESULTS: Myringosclerosis was noticed to a lesser extent in the doxycycline-treated group when compared to the untreated control group. Light microscopy evaluation revealed a difference in the area and thickness of the sclerotic plaques of myringosclerosis of the tympanic membranes in the doxycycline-treated group and the control group, being significantly smaller and thinner in the treated group (P < .001, P < .04, respectively). Similarly, the area and thickness of the sclerotic plaques in the middle ear mucosa were significantly smaller and thinner in the doxycycline treated group (P < .001, P < .03). CONCLUSION: This study demonstrated that the potent matrix metallo-proteinase inhibitor doxycycline plays a preventive role in the development of experimentally induced tympanosclerosis.

Orbital foreign body penetrating from the cheek.

This study emphasizes the importance of diagnostic first aid procedures to avoid the consequences of trauma due to foreign body. A 20-year-old man referred to our hospital with a history of having a sharp penetrating injury to his right eye. Computed tomography evaluation reported right globe perforation and intraorbital glass foreign body measuring 4 x 7 cm was removed. Perforated eye was repaired and traumatic cuts were sutured. Orbital and ocular injuries are common, and delays in management may lead to complication. A team approach is the best technique for these patients.

Topical application of calcium channel blockers to reduce the progression of experimentally induced myringosclerosis and tympanosclerosis.

OBJECTIVES: This study aimed to evaluate the ability of topically applied calcium channel blockers (diltiazem) to reduce the progression of experimentally induced myringosclerosis and tympanosclerosis. STUDY DESIGN: Animal model. Experimental prospective study. METHODS: The study included 25 adult albino guinea pigs that were bilaterally myringotomized and inoculated with a suspension of Streptococcus pneumonia type 3. The right ears were treated with topical application of diltiazem, and the untreated left ears served as the control group. Otomicroscopy and remyringotomy were conducted every week. One animal was sacrificed after 1 week and the remaining at the end of 6 weeks. Temporal bones were dissected, and tympanic bullae were analyzed with light microscopy. RESULTS: The untreated control ears showed evidence of extensive myringosclerosis on otomicroscopy, and the ears treated with calcium channel blockers did as well although to a lesser degree. Under light microscopy, the lamina propria of both tympanic membranes and middle ear mucosae of the control group exhibited thicker (P < .1 and P < .05, respectively) and larger (P < .01 and P < .01, respectively) sclerotic tissue in comparison with the treatment group. CONCLUSION: The results suggest that calcium channel blockers had an influence in the prevention of tympanosclerosis.

Variations of maxillary sinus and accompanying anatomical and pathological structures.

Hypoplasia and aplasia of maxillary sinus, maxillary sinus septae, ethmomaxillary sinus, superior meatus-draining maxillary sinus, and over-pneumatization are the variations of maxillary sinuses. Findings such as uncinate process abnormality, orbital enlargement, sphenomaxillary plate, canine fossa elevation, infraorbital fissure enlargement, thickening of the sinus wall and mucosal pathologies can be seen together with these variations. The aim of this study is to determine the incidence and morphology of the anatomical variations of maxillary sinus and accompanying structures. A total of 330 consecutive paranasal sinus computed tomography scans of the patients presenting with sinonasal complaints at our ENT department were assessed for maxillary sinus anatomical variations and related structures. There were 134 (20.3%) anteriorly and 17 (2.5%) posteriorly localized maxillary sinus bony septa. The position of antral septa was frequently vertical at anterior, and horizontal at posterior. We found significant correlation between the anteriorly localized maxillary sinus septa and infraorbital fissure enlargement. Maxillary sinus hypoplasia was found in 31 (4.6%) maxillary sinuses. Seven (1.0%) ethmomaxillary sinuses were assessed. Significant correlation was found between maxillary sinus hypoplasia and orbital enlargement. Presence of mucosal pathology was significant in patients with maxillary sinus septa, but there was no difference when it was compared with the mucosal pathology in the nonseptated group. There was no significant correlation between other anatomical variations and mucosal pathologies. Determining the anatomical variations of maxillary sinus and accompanying structures in patients planning endoscopic sinus surgery will significantly help with providing surgical orientation and preventing possible complications.

Vestibular nerve functions in children with auditory neuropathy.

In disorders affecting the cochlear nerve it is highly probable that the vestibular nerve is involved as well. The caloric test and VEMP (vestibular evoked myogenic potentials) enable a separate evaluation of the inferior and superior vestibular nerve. In the present study we evaluated the inferior and superior vestibular nerves in three children with auditory neuropathy. Electrophysiological tests, VEMP and caloric tests were carried out in these three cases with the preliminary diagnosis of auditory neuropathy. Magnetic resonance imaging was obtained which revealed an intact cochlear nerve in all three patients. The caloric tests were all normal, while in two out of the three cases the VEMP test yielded abnormal results. Since the caloric test may prove abnormal as well, as reported in the literature, it would be valuable to carry out both of the tests in the vestibular evaluation of children with auditory neuropathy, in our opinion.

The extent and levels of tinnitus in children of central Ankara.

OBJECTIVE: The objective of this study is to determine the presence and prevalence of tinnitus among primary school and junior high school students in central Ankara. METHODS: In the first stage of the study, all students were tested for the presence of tinnitus by answering a comprehensive questionnaire. The students who had previous ear operations were excluded from the rest of the study. The initial survey/tests yielded presence of tinnitus, frequency of occurrence, characteristics, associated symptoms and the age groups. RESULTS: 15.1% of the children reported to have tinnitus. No significant difference was found between gender (female 45.5%, male 54.4%) and ears (right 25.3%, left 25.5%). The age group that suffered most from tinnitus is 14 years old (20.8%), 25 children had positive family history (16.2%), 44 children had headaches as the most common accompanying symptom (28.6%), 64 of them had tiredness as the predisposing factor (41.6%) and 52 of them have defined worsening of tinnitus during mornings (33.8%). The characteristics of tinnitus were identified as high pitch (n=125, 81.2%), soft loudness (n=124, 80.5%) and ringing (n=61, 39.6%). CONCLUSIONS: The study produced much needed data to shed light onto understanding levels and characteristics of tinnitus in school children in Turkey. The data obtained was carefully analyzed and found to be comparative to international studies.

Otoacoustic emissions in children with otitis media with effusion.

OBJECTIVES: Otoacoustic emissions (OAE) are transmitted from the cochlea to the ear canal via the middle ear and the transmission properties of the middle ear directly influence OAE characteristics. The purpose of this study was to establish the mechanisms of changes occurred in middle ear by tympanometric, audiometric and OAE examination. METHODS: Audiometric and tympanometric examination were performed and otoacoustic emissions were recorded from 22 normal ears and 52 ears with middle ear effusions and repeated 3 months later. RESULTS: Results of the air conduction in study group were significantly different from the control group and we found significant recovery in 3 months. When we analysed the DPOAE evaluation results in our study, some of the DPOAE parameters were found to be different between the control and the study group at low frequencies. Changes in the amplitude, especially at low frequencies, were statistically significant after 3 months. CONCLUSION: The results of this study revealed that measurement of otoacoustic emissions, especially distortion product otoacoustic emissions, is helpful in evaluating the condition of middle ear during the treatment.

[Microbiology of the external auditory canal in patients with asteatosis and itching]. / Asteatosis ve kasintili hastalarda dis kulak yolu mikrobiyolojisi.

OBJECTIVES: We examined the microbiology of the external auditory canal in patients with asteatosis and itching and evaluated the efficacy of topical 2% alcohol and boric acid solution in patients with normal flora. PATIENTS AND METHODS: Bacteriological and mycological cultures were obtained from 76 ears of 45 patients (36 females, 9 males; mean age 41.8 years; range 17 to 66 years) presenting with normal otoscopic findings and no history of ear diseases. Treatment protocols were planned according to the culture results. Patients with normal flora were administered topical 2% alcohol and boric acid solution to relieve itching. RESULTS: Cultures yielded normal flora in 65 ears (85.5%), bacterial pathogenic flora in 10 ears (13.1%), and mycosis in one ear (1.3%). Complaints of itching decreased significantly following treatment with alcohol and boric acid solution in patients with normal flora (p<0.05). No correlation was detected between age and the severity of itching (p>0.05). CONCLUSION: Despite normal otoscopic findings, external auditory canal cultures may show pathogenic colonization in patients with asteatosis. Topical administration of alcohol and boric acid solution seems to relieve itching in patients with normal flora.

An unusual site for an intraoral schwannoma: A case report.

Schwannomas are benign tumors that are rarely found in the oral cavity. We presented a schwannoma arising from the parasympathetic fibers of the lingual nerve, which is the first in the literature to our knowledge. Its borders in computerized tomography are not well defined despite the contrast medium.