Rhinitis medicomentosa and substance addiction.

BACKGROUND: Rhinitis medicomentosa (RM) is a form of non-allergic rhinitis caused by the use of nasal decongestants for longer than the recommended duration. Because of this problem of use, addiction to the drug occurs in individuals. In our study, we aimed to evaluate the susceptibility of RM patients to substance addiction. METHODS: The study was planned as a prospective, multicentric study between September 2022 and September 2023. Patients diagnosed with RM were included in the study. Beck depression scale, Drug use disorders identification test, Substance Abuse Proclivity Scale were applied to the patients participating in the study. The research data were analyzed electronically with SPSS program version 25. RESULTS: The study included 86 patients with an average age of 31 years. The average duration of medication use was 22 months. Age, gender, duration of nasal congestion, duration of drug use and smoking were not independent predictors for depression and substance use tendency. CONCLUSION: The relationship between RM and addictive substances is not clear. The tendency to use drugs did not increase in RM patients. In the light of these data, we think that there is no need for a practice other than routine functioning in the use of drugs and similar substances that are likely to cause addiction in RM patients.

The Effect of Rosmarinic Acid on Wound Healing of Nasal Mucosa in the Rats.

BACKGROUND: The nose can be damaged by environmental pollutants and foreign bodies, as well as a result of trauma, infection or surgical interventions. Proper healing of the damaged nasal mucosa is important for health. OBJECTIVE: There is no study in the literature investigating the effects of rosmarinic acid on mucosal healing. The aim of this study was to investigate the effect of rosmarinic acid on nasal mucosal healing. METHODS: 21 male, adult Spraque Dawley albino rats were divided into three groups as the control group, the local treatment group in which rosmarinic acid was applied locally to the nasal mucosa, and the systemic treatment group in which rosmarinic acid was injected intraperitoneally. The wound area was obtained by creating a trauma area by inserting a 10 mm interdental brush through the right nasal nostril into the right nasal cavities of all animals. For the following 15 days, the treatment agent was applied as indicated once a day and on the 15th day the animals were decapitated and tissue samples taken from the nasal mucosa were prepared for histopathological examination. The preparations were examined in terms of cellular hyperplasia, goblet cell hypertrophy and degeneration, leukocyte infiltration, cilia loss and degeneration, edema and vascular dilatation, and they have been classified into four categories as mild (+), moderate (++), severe (+++) and very severe (++++). RESULTS: There was a significant difference between the groups in terms of all parameters evaluated, and there is a decrease in the intensity of the parameters with transition from the control group to the local group and from there to the systemic group. CONCLUSION: Systemic rosmarinic acid administration showed an enhancing effect on the healing of experimentally induced nasal mucosal injury due to its possible anti-inflammatory effect.

Protective and Therapeutic Effect of Platelet-Rich Plasma on Experimental Cisplatin Ototoxicity.

Objective: Cisplatin is a chemotherapeutic agent with an ototoxic effect that is frequently used in head and neck cancers. There are studies in the literature conducted with various antioxidant substances to protect and/or prevent ototoxicity. This study aims to investigate whether platelet-rich plasma (PRP) has a protective and therapeutic effect on cisplatin ototoxicity. Methods: A total of 40 Sprague Dawley albino rats were divided into six groups as control group (n=6), PRP-only group (n=6), cisplatin group (n=6), cisplatin + PRP group (n=6), PRP + cisplatin group (n=6), and donor group (n=10). At the beginning of the study and the 8th day, they were tested with distortion product otoacoustic emission (DPOAE). Assessment of DPOAE results was based on the signal-to-noise ratio in 2000, 3000, 4000, 6000, and 8000 Hz frequency bands. On the 8th day, the rats were sacrificed. For histological examinations, the temporal bones were dissected and fixed. After hematoxylin and eosin staining, the tissues were evaluated by light microscopy. Results: In the DPOAE tests performed on the 0th and 8th days of the cisplatin group, it was observed that cisplatin caused hearing loss in the rat ears. It was determined that the cisplatin group at 2000 Hz, 3000 Hz and 4000 Hz had a significant decrease in hearing compared to all groups (p<0.015), while the cisplatin group at 6000 and 8000 Hz was characterized by hearing loss at a higher rate than all groups (p<0.001). At the end of the study, negative effects of cisplatin on both cellular dimensions (cytoplasmic vacuolization, cell degeneration, dilatation, apoptotic cells, nerve degeneration) and hearing function were observed. No protective or therapeutic effect of PRP on cisplatin ototoxicity was observed. Conclusion: Our study showed that platelet-rich plasma did not have a significant effect in the treatment of hearing loss due to cisplatin ototoxicity and in preventing hearing loss in rats.

Mechanism of ear canal button battery injury and strategies for mitigation of damage.

Objectives: In this study, the damage caused by button batteries (BB) trapped in the ear canal (EC) and strategies to reduce this damage before their removal were investigated in vitro. Methods: After four EC models prepared from freshly frozen cadaveric bovine ears were thawed, 3 V lithium BBs were placed in the channels. After a three-hour period of preliminary damage, nothing was applied to the first EC model, the second EC model underwent saline administration, the third EC model underwent boric acid administration, and the fourth EC model underwent the administration of 3% acetic acid. The voltage, tissue temperature, and pH of the BBs were measured. The BBs were removed at the end of the 24th hour, and the EC models were examined by a pathologist. Results: The greatest decrease in pH was detected in the fourth EC model in which acetic acid was administered. The depth of necrosis was 854 µm in the first EC model, 1858 µm in the second EC model, and 639 µm in the third EC model at the end of the 24th hour. No necrosis was detected in the fourth EC model. Conclusions: Lithium BBs can cause alkaline tissue damage in a short time in cadaveric EC models. pH neutralisation strategies appear to be experimentally successful under in vitro conditions.

Bilateral temporomandibular joint luxation in a 6-month-old child: Case report.

BACKGROUND: Luxation of the temporomandibular joint (TMJ) is an acute condition associated with translocation of the condylar joint out of its functional position. Traumatic causes are more common in childhood, while non-traumatic causes are very rare. CLINICAL PRESENTATION: A 6-month-old patient was brought to a rural hospital emergency department with the inability to close her mouth. The patient was diagnosed with anterior TMJ luxation after the examination, and no additional imaging was requested. Reduction was performed with gas sedation accompanied by paracetamol for pain. CONCLUSION: In rare cases, non-traumatic TMJ luxation may be observed after excessive crying or vomiting in infants. Examination findings are generally sufficient for diagnosis. Reduction is performed with the classical manual method, especially in childhood. One issue that should not be ignored is the possibility of recurrence after dislocation.

Mucin receptors in chronic rhinosinusitis with nasal polyps.

BACKGROUND: Nasal polyps (NPs) are non-neoplastic, painless inflammatory lesions of the sino-nasal mucosa. Nasal polyp physiopathology is not yet fully understood. There are many potential etiologies of NP, including chronic infections, allergies, asthma, aspirin sensitivity, anatomical disorders, and genetic causes. OBJECTIVE: The purpose of our study was to immunohistochemically demonstrate the presence of mucin (MUC) receptors in chronic rhinosinusitis (CRS) with nasal polyps and determine the relationships between the presence of these receptors and clinical findings. MATERIAL AND METHODS: A total of 59 patients who underwent functional endoscopic sinus surgery due to CRS with NPs were included in the study. Groups with positive and negative MUC receptors were evaluated according to their clinical characteristics. RESULTS: According to the data we have obtained, surgery site quality and low-dose steroid response worsened with MUC5A receptor positivity and there were no significant relationships between MUC1 receptor positivity and clinical findings. CONCLUSION: According to our results, MUC5A receptor positivity was associated with impaired surgical site quality and a reduced response to low-dose systemic steroids by NPs.

Evaluation of age-related changes in middle-ear structures by wideband tympanometry.

BACKGROUND: Presbycusis is bilateral sensorineural hearing loss associated with the progressive degeneration of cochlear and central auditory pathways with aging. AIMS/OBJECTIVES: We aimed to reveal age-related changes in middle ear function by using wideband tympanometry (WBT). MATERIALS AND METHODS: Fifty-eight patients diagnosed with presbycusis were compared to 52 audiologically healthy participants. WBT measurement was performed on both ears via wideband click stimulus with a tympanometer device using probe tone frequencies of 226-8000 Hz. RESULTS: There were no statistically significant differences detected among the resonance frequencies or maximum absorbance ratios measured in both ears between groups (p > .05). The mean absorbance of the right and left ears at 4000 and 8000 Hz was statistically higher in the patient group than in the healthy controls (r = 0.038, 0.030; l = 0.015, 0.012). Moreover, mean compliance values were found to be significantly lower in the patient group than in the control group (r = 0.030 and l = 0.040). CONCLUSION: The significant differences detected in compliance and absorbance values for high frequencies in presbycusis patients were remarkable. Thus, it has been shown that WBT yields an advantage compared to traditional tympanometry in the diagnosis and treatment of middle ear diseases.

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty / Resultados clínicos iniciais da utilização de radiofrequência e lateralização das conchas nasais inferiores combinadas à septoplastia

Abstract Introduction: Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. Objective: This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. Methods: The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. Results: The mean preoperative NOSE scores were 10.3 ± 4.2 in the RF group and 10.9 ± 4.9 in the LAT group, and the mean six-month postoperative scores were 1.09 ± 1.3 in the RF group and 1.2 ± 1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p > 0.05). Conclusion: The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Resumo Introdução: A obstrução mecânica é a forma mais comum de obstrução nasal. Entre os tipos de obstruções mecânicas, o desvio do septo e a hipertrofia de conchas inferiores são os mais prevalentes. Objetivo: Avaliar os resultados clínicos iniciais da aplicação de radiofrequência nas conchas inferiores e a lateralização delas combinada com septoplastia no tratamento dos sintomas de obstrução nasal. Método: O estudo avaliou retrospectivamente dados de 33 pacientes (24 homens, nove mulheres) que foram submetidos a septoplastia e aplicação de radiofrequência no concha inferior (grupo RF) e 32 pacientes (24 homens, oito mulheres) submetidos a septoplastia e lateralização de concha inferior (grupo LAT), que foram admitidos com queixas de obstrução nasal na University of Health Sciences, Departamento de Otorrinolaringologia, entre 1° de janeiro de 2017 e 1° de janeiro de 2018. Os sintomas pré-operatórios e pós-operatórios de 6 meses dos pacientes foram avaliados pela escala NOSE, do inglês Nasal Obstruction Symptom Evaluation. Resultados: Os escores médios pré-operatórios da escala NOSE foram 10,3 ± 4,2 no grupo RF e 10,9 ± 4,9 no grupo LAT e os escores médios pós-operatórios de seis meses foram 1,09 ± 1,3 no grupo RF e 1,2 ± 1,3 no grupo LAT. Não houve diferença significante nos escores da escala NOSE entre os dois grupos (p > 0,05). Conclusão: Os dados obtidos neste estudo mostram que ambos os métodos têm resultados semelhantes em termos de alívio dos sintomas de obstrução nasal em pacientes que necessitam de intervenção nas conchas inferiores. Portanto, os pesquisadores acreditam que, em cada caso, o método de intervenção deve ser selecionado a critério do paciente e do cirurgião.

The Economic Burden of Vertigo: Results From the Hospitalized and Outpatients.

OBJECTIVE: Vertigo and dizziness are the common presenting concerns in emergency departments and outpatient clinics, accounts for approximately 15% to 20% of adults annually. We aimed to evaluate economic burden of vertigo on health-care system and work productivity in association between clinic characteristics of in- or outpatients. METHODS: A total number of 2289 patients diagnosed with peripheric (noncentral) vertigo were evaluated retrospectively. The direct medical costs associated with vertigo classified as medication, consumable, imaging, and laboratory. In addition, the indirect costs were associated with lost working days. The overall economic impact of vertigo assessed via total expenditure for diagnosis and treatment. RESULTS: The mean duration of hospitalization was 5.6 ± 4.3 days and working day lost was 9.47 ± 3.90 days. The overall impact on work productivity of disease was 15.35 ± 6.11 days. The overall mean direct cost including all expenditure items associated with vertigo care was $250.25 ± $1479.62 per patient. The overall cost associated with vertigo was found to be statistically increased in the male, aged ≥65 years, widow or divorced, and hospitalized patients. CONCLUSIONS: Our findings clearly indicate that a vertigo-dizziness management program based on patients' risk factors may achieve to reduce hospitalizations and cost of hospital care as well.

Voice Quality After Radiotherapy and Cordectomy in Early-Stage Glottic Carcinomas.

Laryngeal carcinomas are the most common upper respiratory tract cancers and most commonly involve the glottic region. The aim of this study is to evaluate the voice quality after radiotherapy (RT) and microsurgical cordectomy (MC) treatments using Voice Handicap Index (VHI) and Grade, Roughness, Breathiness, Astenicity, and Strain (GRBAS) perceptual evaluation scale in patients with early-stage glottic carcinoma. A total of 37 patients with early-stage glottic carcinomas, 19 patients had RT and 18 patients with MC, were included in our study. The patients were evaluated in terms of their sound quality by using VHI-10 and GRBAS perceptual assessment scale 3 months after the treatment was completed. Although the findings were better in favor of RT according to GRBAS perceptual assessment scale of patients who received RT (n = 19) and MC (n = 18), no statistically significant difference was found between the 2 groups (P = .613). Patients in both groups were evaluated with VHI-10, emotional (P = .036) and physiological (P = .038) scores were significantly higher in MC group and no significant difference was found in functional scores (P = .192). However, there was no statistically significant difference between the 2 groups in terms of voice quality (P = .185). In early-stage (Tis, T1a, T1b) glottic carcinoma, there was no significant difference between RT and MC in terms of voice quality. Therefore, the choice of treatment modality in patients with early-stage glottic carcinoma should be taken into account in terms of the patient's occupation, comorbid diseases, cost of treatment, hospital stay, and, most importantly, patient preference.

Vestibular Evoked Myogenic Potentials in Patients With Low Vitamin B12 Levels.

OBJECTIVE: Vitamin B12 deficiency-induced hyperhomocysteinemia has been associated with impaired microarterial flow, demyelization, and neuronal damage, resulting in cochlear damage and auditory dysfunction. Therefore, we aimed to evaluate the possible vestibular-evoked myogenic potential (VEMP) abnormalities in patients with vitamin B12 deficiency. MATERIAL AND METHOD: In this prospective study, 37 patients diagnosed with vitamin B12 deficiency (<220 pg/mL) were compared with 31 audiologically healthy participants with normal B12 levels. Burst-evoked cervical VEMP (cVEMP) measurements were performed on all participants. Additionally, cVEMP responses were analyzed for P1-N1 latency, interpeak amplitude, and amplitude asymmetry ratio. The results of audiometric examination and VEMP records as well as absent responses were evaluated and compared between groups. RESULTS: The rate of absent VEMP responses was twice as high in the patient group than in the healthy control group (12 vs 6 cases, respectively). Moreover, the mean values of interpeak amplitude in both right and left ears were statistically shorter in the patient group than the control group (P values = .024 and .007, respectively). Similarly, the mean amplitude asymmetry ratio was statistically higher in the patient group than the control group (P = .050). There were no statistically significant differences in latency responses between groups. Furthermore, positive, statistically significant correlation was detected between values of the left P1-N1 interpeak amplitude and vitamin B12 levels (r = 0.287, P = .037). CONCLUSIONS: Increased rates of absent VEMPs and decreased amplitudes with normal latencies are attributed to peripheral vestibular hypofunction in patients with vitamin B12 deficiency.

Early clinical outcomes of inferior turbinate radiofrequency and lateralization combined with septoplasty.

INTRODUCTION: Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. OBJECTIVE: This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. METHODS: The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. RESULTS: The mean preoperative NOSE scores were 10.3±4.2 in the RF group and 10.9±4.9 in the LAT group, and the mean six-month postoperative scores were 1.09±1.3 in the RF group and 1.2±1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p>0.05). CONCLUSION: The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Perspectives of Young Otolaryngologists on Pediatric ENT and the Future of the Field in Turkey.

OBJECTIVE: The purpose of this study was to examine the current status and the future of pediatric otolaryngology in Turkey by evaluating the opinions of young otolaryngologists on pediatric otolaryngology. METHODS: The study included 224 otolaryngology physicians who were senior residents registered with the Turkish Otolaryngology and Head-Neck Surgery Association (TORL-HNS). The physicians were in their last two years of otolaryngology training (154 physicians) or had completed their residency training and were in their first year of otolaryngology practice (70 physicians). They were approached via e-mail and Short Message Service (SMS) in October through December 2019 with a descriptive letter and asked to voluntarily complete an online questionnaire consisting of total 25 questions in five sections. RESULTS: The online questionnaire was sent to 224 physicians, and 109 (49%) participated in the survey. All 109 participants answered all the questions. Overall, 71 participants (65.1%) were in training for residency and 38 (34.9%) were in their first year of expertise. According to their professional interests, the participants listed rhinology (45 participants, 41.3%), head and neck surgery (27 participants, 24.8%), facial plastic surgery (19 participants, 17%), otology-neurotology (16 participants, 14.7%), and laryngology-phoniatry (2 participants, 1.8%) as their first preference for subspecialty. Pediatric otolaryngology was never a first choice among the participants, although four (3.7%) listed pediatric otolaryngology as their second preference. CONCLUSION: The aim of this study was to shed light on the current and future status of pediatric otolaryngology in Turkey. We believe the establishment of exclusive pediatric otolaryngology clinics under the umbrella of general ear, nose and throat (ENT) clinics and the foundation of officially approved fellowship programs would bring this subspecialty field to its deserved and desired level in our country.

Postauricular Island Flap in Reconstruction of Auricula Tumor Defects.

The most common malignant tumor in humans is skin cancers. Skin cancers are most commonly seen in the head and neck region due to direct exposure to sunlight. Most frequently seen skin cancer in the auricula are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study is to evaluate the results of postauricular island flap after resection of tumors in the auricula.Twelve patients aged 58 to 84 years were included in the study. Eight patients had BCC, 3 had SCC, and 1 had basosquamous carcinoma (BSC). The tumor was located at the cavum concha in 7 cases, antihelix in 3 cases, triangular fossa in 1 case and scapha in 1 case. Surgical procedure was performed under local anesthesia in 7 patients and under general anesthesia in 5 patients. Postauricular island flap was used in all cases. There were no early complications. Three patients had non-apparent narrowing of the auriculomastoid angle. The patients were followed for an average of 2.6 years between 1 and 9 years. Only one patient with basosquamous carcinoma of the cavum concha had recurrence at 19 months.We believe that the postauricular island flap may be a good alternative for the reconstruction of the defect after resection of tumors in the auricle due to its proximity to the surgical site, color matching, adequate thickness, good vascularization, aesthetic acceptance by the patient and completion of the procedure in one session.

Bone turnover in chronic otitis media with bone destruction.

PURPOSE: This study aims to determine the relationship between bone destruction and bone turnover markers in patients with chronic otitis media (COM). METHODS: Subjects with COM were divided into two groups: those with and without bone destruction. Thirty-seven patients were included in the group with bone destruction; 30 patients were included in the group without bone destruction. The enzyme values were evaluated. RESULTS: There was no difference between the two groups in terms of enzyme levels of serum and urine. However, the osteocalcin, which is a bone formation marker, and the C-terminal telopeptide of type I collagen marker, which is bone destruction marker, were found to be lower in the group with bone destruction than the group without bone destruction. CONCLUSION: Data obtained in the present study suggest that the pressure necrosis theory and acid lysis theory provide the most valid explanations of bone destruction. However, the data provide limited preliminary information to clarify this mechanism.

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly.

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4 ± 5.24 dB. The mean ABG was 9.2 ± 2.13 dB 1 month postoperatively and 8.5 ± 2.26 dB 6 months postoperatively (p < .005).Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn't require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.

Classification of laryngeal injury in patients with prolonged intubation and to determine the factors that cause the injury.

OBJECTIVE: This study aims to evaluate injuries occurring in the larynx of patients intubated in intensive care units for a long time. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary hospital. SUBJECT AND METHODS: Between April 15, 2019, and November 15, 2019, 40 patients who were hospitalized in intensive care units had a tracheotomy procedure due to prolonged intubation, and laryngeal structures were evaluated by direct laryngoscopy. The laryngeal structures were evaluated in four groups as glottic-supraglottic region, arytenoid vocal process, interaritenoid region and subglottic region. Edema, granulation and ulceration findings in these four regions were recorded. The injuries to the laryngeal structures were classified as stages 0-3. As a result of the data obtained, the relationship between the degree of laryngeal lesions and the factors that may cause these lesions was investigated. RESULTS: According to our classification, nine patients had stage 1, 16 patients had stage 2 and 15 patients had stage 3 laryngeal injury. There was no significant relationship between the stage of laryngeal injury and age, sex and diameter of the intubation tube. There was a statistically significant relationship between laryngeal injury and the day the tracheotomy was performed (p = 0.007). CONCLUSION: In patients that had prolonged endotracheal intubation, injury to the laryngeal structures is inevitable. To minimize this occurrence, tracheotomy should be performed for intubations that extend for more than seven days. When performing the tracheotomy, the laryngeal structures should be evaluated, necessary precautions should be taken for the traumatic lesions that are difficult to heal, and treatment should be started.

Does Postauricular Incision Cause Auricula Protrusion After Tympanoplasty?

BACKGROUND: An ear surgery can be performed via transcanal, endaural, or postauricular approach according to the surgeon's desicion. The postauricular one is the most commonly performed approach. OBJECTIVE: The objective of this study was to evaluate whether preferring postauricular approach during ear surgery cause auricular protrusion in over time. METHODS: Thirty-six patients who underwent tympanoplasty operation with postauricular incision were included in this study. Any patient who was under 18 years of age, those with auricular deformity and patients who underwent tympanoplasty operation with mastoidectomy were excluded from this study. The distances from mastoid area to superior and mid-point of helix were measured preoperatively and 1 year postoperatively. RESULTS: A total of 36 patients' data were analyzed. There were 13 males and 23 females. The mean age was 28.2 ±â€Šyears (18-59). The preoperative mean distance from mastoid area to superior point of helix was 15.03 ±â€Š2.86 mm, whereas it was 17.92 ±â€Š2.96 mm at mid-helix level. At postoperative 1 year, the same distances were measured 14.67 ±â€Š3.12 mm and 17.25 ±â€Š3.17 mm, respectively. There were no statistically significant differences between preoperative and postoperative measures. CONCLUSION: Although the structures that provide the stability of the auricle are cut during postauricular sulcus incision, long-term follow-up of patients did not show any protrusion of auricula.

Vestibular evoked myogenic potential (VEMP) results in migraine and migrainous vertigo.

Background: The pathophysiology of vertigo is not fully known; thus, it is difficult to diagnose vestibular migraine (VM) in some migraine patients with vertigo symptoms.Aims/objectives: We aimed to evaluate the diagnostic value of cervical vestibular evoked myogenic potential (cVEMP) in patients with VM.Materials and Methods: Thirty-two patients diagnosed with migraine and 31 patients with VM were prospectively included in this study. The cVEMP responses were obtained, and P1-N1 latency, interpeak amplitude, amplitude asymmetry ratio were calculated. The patients' demographics, results of physical and audiometric examinations, and VEMP records as well as absence of responses were evaluated and compared between groups.Results: The incidence of ears with absence VEMP responses was found to be numerically higher in the migraine group than in the VM group (p = .106). Additionally, there were no statistically significant differences detected between the groups in terms of the p13 or n23 latency, interpeak amplitude, and amplitude asymmetry ratio measured in both right and left ears (p > .05).Conclusions: The increased rate of absent VEMPs was associated with the hypoperfusion of the sacculo-collic reflex pathway in migraine patients. In addition, it was concluded that VEMP reflex responses appear to be insufficient to differentiate between VM and migraine diagnoses.