Differentiation of peripheral and non-peripheral etiologies in children with vertigo/dizziness: The video-head impulse test and suppression head impulse paradigm.

OBJECTIVES: To identify the etiology of vertigo/dizziness and determine the effectiveness of the video-head impulse test (vHIT) and the suppression head impulse paradigm (SHIMP) tests in distinguishing between peripheral and non-peripheral etiologies in children who presented to the otolaryngology department with complaints of vertigo/dizziness. METHODS: The vHIT and SHIMP tests were applied to the children. The vestibulo-ocular reflex (VOR) gain and saccade parameters were compared. RESULTS: In 27 children presenting with vertigo/dizziness, the most common etiological factor was inner ear malformation (IEM) (n = 6/27, 22.2%), followed by cochlear implant surgery (11.1%) and migraine (11.1%). Vestibular hypofunction was indicated by the vHIT results at a rate of 60% (9/15 children) and SHIMP results at 73.3% (11/15 children) among the children with a peripheral etiology, while these rates were 8.3% (1/12 children) and 25% (3/12 children), respectively, in the non-peripheral etiology group. SHIMP-VOR and vHIT-VOR gain values had a moderate positive correlation (p = 0.01, r = 0.349). While there were overt/covert saccades in the vHIT, anti-compensatory saccade (ACSs) were not observed in the SHIMP test (p = 0.041). The rates of abnormal vHIT-VOR gain (p = 0.001), over/covert saccades (p = 0.019), abnormal vHIT response (p = 0.014), ACSs (p = 0.001), and abnormal SHIMP response (p = 0.035) were significantly higher in the peripheral etiology group. CONCLUSIONS: IEM was the most common etiological cause, and the rate of vestibular hypofunction was higher in these children with peripheral vertigo. vHIT and SHIMP are effective and useful vestibular tests for distinguishing peripheral etiology from non-peripheral etiology in the pediatric population with vertigo/dizziness. These tests can be used together or alone, but the first choice should be the SHIMP test, considering its short application time (approximately 4-5 min) and simplicity.

Acute Otitis Media with Intracranial and Intratemporal Complications: A Case Study.

Acute otitis media continues to be one of the most common infections today and a major cause of the prescription of antibiotics in the pediatric age group. Complications of this condition are rare, especially when antibiotic therapy is started early; however, complications related to acute otitis media cause dramatic morbidity. This report provides a review related to a case of acute otitis media with bilateral intracranial and intratemporal complications.

An Experimental Comparison of the Analgesic and Anti-Inflammatory Effects of Safflower Oil, Benzydamine HCl, and Naproxen Sodium.

The study aims to establish how feasible a natural therapy option (safflower oil) is in the treatment of postoperative pain. Naproxen sodium has already been experimentally proven to be effective for this purpose. Accordingly, the analgesic and anti-inflammatory effects of safflower oil were compared with those obtained with benzydamine HCl and naproxen sodium. Forty-two, healthy, adult female rats of Wistar albino species were divided at random into six groups of seven rats. The intervention allocation was as follows: Group No. 1-physiological saline 0.9%; Group No. 2-safflower oil 100 mg/kg; Group No. 3-safflower oil 300 mg/kg; Group No. 4-benzydamine HCl 30 mg/kg; Group No. 5-benzydamine HCl 100 mg/kg; and Group No. 6-naproxen sodium 10 mg/kg. Following allocation of treatment, pain was induced experimentally and tested in various ways (hot plate test, tail-pinching test, and writhing test) and the efficacy of each treatment in providing peripheral and central analgesia was evaluated. The second stage consisted of providing different treatments to four groups (groups 7-10) of seven rats each, chosen at random. The allocations were as follows: Group No. 7-physiological saline 0.9%; Group No. 8-safflower oil 300 mg/kg; Group No. 9-benzydamine HCl 100 mg/kg; and Group No. 10-naproxen sodium 10 mg/kg. To create experimental inflammation, 2% formaldehyde was injected into the experimental animal's paw and the resulting edema was measured and recorded for a 10-day period. Edema inhibition was calculated as a percentage. The rats were sacrificed and the paw and stomach dissected for histopathological examination. The data were used for statistical analysis, using the Shapiro-Wilk, Kruskal-Wallis H test, and two-way analysis of variance. In the tail-pinching test, it was determined that a 300 mg/kg dose of safflower oil shows central spinal analgesic efficacy and this effect is close in magnitude to 10 mg/kg of the reference material, naproxen sodium. In the squirming test, it was observed that the 100 and 300 mg/kg doses of safflower oil had a peripheral analgesic effect when compared with the serum physiological (placebo) group. The peripheral efficacy of 300 mg/kg safflower oil was found to approximate that of 10 mg/kg naproxen sodium. In rats treated with benzydamine HCl 100 mg/kg, similar peripheral analgesic efficacy to naproxen sodium 10 mg/kg was noted. In the hot plate test, no difference in the analgesic efficacy between the various agents was found. The change in inhibition of edema between the 1st and 10th days was most marked in rats receiving naproxen sodium 10 mg/kg. A significant difference was determined in the safflower oil 300 mg/kg and benzydamine HCl 100 mg/kg groups (P < .001). Regarding histopathology findings in the rat paw, significant differences were seen in venous congestion between placebo and safflower oil 300 mg/kg and in inflammation between the control and benzydamine HCl 100 mg/kg groups. Regarding the histopathology findings in the rat stomach, significant differences were observed in venous congestion between placebo and safflower oil 300 mg/kg; in damage to the epithelium between placebo and safflower oil 300 mg/kg and between naproxen sodium 10 mg/kg and safflower oil; and in cell infiltration and development of edema between placebo and safflower oil 300 mg/kg. It is predicted that further research into safflower oil and benzydamine HCl will create opportunities to develop analgesic-anti-inflammatory therapeutics of a novel kind for the treatment of postoperative pain and inflammation.

Is Transnasal Endoscopic Marsupialization Sufficient in Thornwaldt Cysts?

OBJECTIVE: Thornwaldt cyst is a rare nasopharyngeal lesion that develops from primitive notochord residues. The aim of this study is to evaluate the long-term results of transnasal endoscopic marsupialization surgery in the treatment of Thornwaldt's cyst, its success and its qualification in the treatment. METHOD: The data of 21 patients who underwent transnasal endoscopic marsupialization surgery for symptomatic Thornwaldt cyst in our hospital between 2009 and 2015 and followed up regularly after the operation were reviewed retrospectively. RESULTS: Eleven patients were female and 10 were male. The mean age of the patients was 35.5 years (15-60). All patients underwent transnasal endoscopic marsupialization as a surgical technique. No intraoperative and postoperative complications were observed. In all cases, the complaints regressed postoperatively. There was no recurrence at 4-year follow-up. CONCLUSION: Transnasal endocopic marsupialization as a surgical method can be performed safely in Thornwaldt cyst cases because of its easy applicability, short surgical time, low recurrence rates and efficacy in treatment.

Acoustic Analysis of Soccer Fans in Acute Phonotrauma After the Match.

OBJECTIVES: Acute phonotrauma is the result of sound production by shouting or straining one's voice. In this study, we aimed to investigate the acute changes in the vocal folds and voices of soccer fans who voluntarily applied to our clinic after the soccer match where they engaged in acute phonotrauma. There are no other studies in the literature conducted on a similar sample group. STUDY DESIGN: This is a case-control study. METHODS: Videolaryngostroboscopic (VLS) examination, acoustic voice analysis, and Voice Handicap Index (VHI) questionnaire were performed on 29 voluntary soccer fans included to the study before the match and at the first hour after the match. The values obtained were compared statistically with each other and with 29 control groups without voice pathology. RESULTS: The jitter, shimmer, and normalized noise energy values measured after the match increased significantly statistically compared with the pre-match level, but harmonic noise ratio value decreased significantly (P < 0.05). VHI scores increased significantly after the match according to the pre-match scores (P < 0.05). In the VLS examinations, there was no difference in the images before and after the match. CONCLUSIONS: It has been concluded that people who are using their voices loudly and intensely by shouting during the match are exposed to sound changes after the match, and if this situation becomes persistent, it may cause permanent voice pathologies. It is thought that VHI and acoustic voice analysis should be done together with VLS for diagnosis and follow-up of voice changes for which the VLS examination alone is not sufficient.

Diagnostic role of ultrasound elastography on lymph node metastases in patients with head and neck cancer.

INTRODUCTION: Ultrasonography is the easiest non-invasive method to diagnose lymph node metastases in patients with head and neck cancer. However, since CT scans are often preferred in the evaluation of primary tumours of these patients, information about lymphatic metastases may also available in these patients. Therefore, ultrasound is not routinely employed in the evaluation of these patients. However, elastography technique, a recent development in ultrasound technology, could make use of ultrasonography in these patients even more widespread, even though it is still not widely used today. OBJECTIVES: The aim of this study was to evaluate the role of sonographic elastography in the diagnosis of lymph node metastasis of head and neck cancer. METHODS: Twenty-three patients diagnosed with head and neck cancer and scheduled for surgical treatment including neck dissection were included in the study. All patients underwent neck examination by palpation, ultrasound elastography and computerized tomography with contrast. To compare the diagnostic performance of palpation, ultrasound elastography and computerized tomography, the findings of each examination method were compared with the histopathological examination results of neck specimens. RESULTS: 15 (65.2%) patients had a primary tumour in the larynx; 7 (30.4%) in the oral cavity; and 1 (4.3%) in the parotid. 7 (30.4%) out of 23 patients underwent bilateral neck dissection. In total, 30 neck dissections were hereby taken into account during study. Ultrasound elastography showed higher accuracy (83.3%) and higher sensitivity (82.4%) than palpation and computerized tomography, but the specificity of ultrasound elastography was lower (84.6%) than palpation and computerized tomography. CONCLUSIONS: Ultrasound elastography is helpful for the diagnosis of lymph node metastases in patients with head and neck cancer. Due to its non-invasive character, it can be used safety in combination with other radiological techniques to support or improve their diagnostic performance.

Efficacy of Platelet-Rich Plasma on Fat Grafts in the Repair of Tympanic Membrane Perforations: An Experimental Study.

OBJECTIVE: We investigated the use of autologous platelet-rich plasma (PRP) to improve the success rate of fat graft myringoplasty in perforated tympanic membranes of rats. MATERIALS AND METHODS: A total of 20 healthy Wistar albino female rats were divided into two groups. In Group 1, the left tympanic membranes were perforated and grafted with a fat graft that was harvested from the inguinal region. In Group 2, the left tympanic membranes were perforated, and a fat graft was also harvested from the inguinal region. Then, the fat was soaked in 0.5 mL PRP and grafted at the perforation. After the procedure, the rats were examined, and the graft situation was assessed at 3, 5, 7, 10, and 14 days. All of the rats were sacrificed 21 days after perforation, and a histopathological examination was made. RESULTS: We compared fat graft histopathological and otomicroscopic findings between the groups. While we did not observe graft rejections in Group 2, we saw 1 case of graft rejection in Group 1. In the histopathological examination, PRP prevents fat graft resorption by the terms of the adipocyte area, granulation tissue area, and vacuolization area. CONCLUSION: This study demonstrated the efficacy of fat grafts prepared with PRP on rat tympanic membranes. The fat graft with PRP did not statistically improve the success rate compared to the graft without PRP. Histopatologic findings of the study showed that PRP prevents fat graft resorption. Further studies are needed to further examine the advantages of the graft with PRP.

Cochlear Implantation in Patients with Keratitis-Ichthyosis-Deafness Syndrome: A Report of Two Cases.

BACKGROUND: Keratitis-ichthyosis-deafness (KID) syndrome is a syndrome which presents with hearing loss and visual and keratinization disorders. In such patients, hearing aids cannot be effectively used in the rehabilitation of hearing loss because of the frequent blockage of the external ear canal with epithelial debris and due to dry and tense skin of the external ear canal. Moreover, severe or profound hearing loss also limits the benefits gained from the conventional hearing aids. On the other hand, cochlear implantation is a method that has been used in limited cases in the literature. CASE REPORT: This study presents the results of cochlear implantation applied in our clinic to two children who had been diagnosed with KID. Audiological assessments before and after the cochlear implant operation were performed using pure-tone audiometry, immittance audiometry, and auditory brainstem response (ABR), and the postoperative follow-up was conducted using pure-tone audiometry. CONCLUSION: Skin problems, visual disturbances, and other additional problems complicate the short-term and long-term rehabilitation after implantation in individuals with KID syndrome. Close monitoring should be exercised due to possible skin complications that may develop during the postoperative period. The families and rehabilitation teams should be warned about the possible visual disturbances and skin complications.

Mechanism of action of allergen immunotherapy.

BACKGROUND: Allergen immunotherapy (AIT) leads to the production of antiallergen immunoglobulin (IgG) or "blocking antibody" in the serum and an increase in antiallergen IgG and IgA in nasal secretions. There is also a decrease in the usual rise in antiallergen IgE that occurs after the pollen season. METHODS: In this paper, mechanisms of action of allergen immunotherapy is reviewed. RESULTS: Regulatory T (Treg) cells and their cytokines, primarily interleukin (IL) 10 and transforming growth factor beta, suppress T-helper type 2 immune responses and control allergic diseases in many ways. AIT induces a shift in the proportion of IL-4-secreting T-helper type 2 cells in favor of IL-10-secreting inducible Treg cells specific for the same allergenic epitope that increases in number and function. Different types of inducible Treg control several facets of allergic inflammation. There are two main types of immunotherapy: subcutaneous immunotherapy and sublingual immunotherapy. Subcutaneous immunotherapy is efficacious and is indicated for the reduction of seasonal symptoms. Sublingual immunotherapy involves the regular self-administration and retention of allergen extract under the tongue for 1-2 minutes before the extract is swallowed. The allergens cross the mucosa in 15-30 minutes and are then captured by tolerogenic dendritic cells and processed as small peptides. Next, via the lymphatic system, a systemic immune response is created to produce an early decrease in mast cell and basophil degranulation. CONCLUSION: AIT is indicated for the treatment of moderate-to-severe intermittent or persistent symptoms of allergic rhinitis. AIT can be administered to those >5 years of age and has been shown to be safe in children as young as 3 years of age. In this article, AIT and other types of immunotherapies were discussed as well as the indications for immunotherapy.

Lingual Osseous Choristoma.

An osseous choristoma is a rare benign lesion consisting of normal bone tissue; it is seen in abnormal locations. It is most often seen in the posterior 1/3 of the tongue in the head. Its etiopatogenesis is controversial, and till date, less than 100 cases have been reported in the literature. Although a lingual osseous choristoma is asymptomatic, in some patients, symptoms such as swelling sensation in the throat, globus pharyngeus, dysphagia, retching, nausea, and sore throat have been reported. In this article, a 41-year-old female patient admitted to our clinic with throat pain and globus pharyngeus who underwent an excision from the region of radix lingua and the result of histopathological examination was reported as "osseous choristoma" was presented and related literature is reviewed.

The Analysis of Patients Operated for Frontal Sinus Osteomas.

OBJECTIVE: Paranasal sinus osteomas are benign tumors that are smooth-walled, slow-growing, and induced by bone tissue. Although their most common localization is the frontal sinus, some osteomas are seen in the ethmoid, maxillary, and sphenoid sinuses. Frontal sinus osteomas are often asymptomatic; however, when they become symptomatic, headache is the most common complaint. In this study, we aimed to analyze the postoperative results of patients who were diagnosed with frontal sinus osteoma and were operated with appropriate surgical techniques. METHODS: We retrospectively evaluated 14 patients who were diagnosed with frontal sinus osteoma and were operated in our department between March 2009 and July 2014. The following parameters were analyzed: patients' age and gender, complaints at the time of admission to our clinic, pathological findings from physically examination, tumor features observed in preoperative paranasal sinus computed tomography (size and localization), surgical methods applied, intra- and postoperative complications, and recurrence rates. All patients preoperatively provided informed consent. RESULTS: Of the 14 patients, 7 were males and 7 were females, with a mean age of 40.57 years. A total of 11 (79%) osteomas were located within the frontal sinus and 3 (21%) within the frontal recess. External surgical approach was performed to 11 patients, endoscopic approach was performed to 2 patients and external and endoscopic approach was performed to 1 patient together. CONCLUSION: Although the preferred surgical method in frontal sinus osteoma depends depended on size and localization of tumors, experience of surgeon is also important. Although the external surgical approach is appropriate for large and laterally localized osteomas, the endoscopic approach is appropriate for small and inferomedially localized osteomas. In both surgical approaches the site of origin should be drilled.

[Quality of life before and after surgery in patients with nasal polyposis]. / Nazal polipli hastalarda ameliyat öncesi ve sonrasi yasam kalitesi.

OBJECTIVES: The postoperative symptoms, paranasal computed tomography (CT) findings and quality of life of the patients who had undergone surgical treatment for nasal polyposis were evaluated. PATIENTS AND METHODS: This study included 32 patients (18 females, 14 males; mean age 43 years; range 14 to 64 years) who applied to our clinic between January 2008 and January 2009 and were operated on with diagnosis of pure nasal polyps. In addition, 36 healthy volunteers were randomized to the control group. The patients were evaluated before and after surgery, on the 3rd week and 3rd month with routine ear nose and throat physical examination and through the Short Form-36 (SF-36) questionnaire as the nasal symptom scores and quality of life. The SF-36 questionnaire was used in the control group as well. In this SF-36 questionnaire the patients were evaluated for eight domains. Control paranasal CT findings at 6th months after surgery were compared with the CT findings before surgery. RESULTS: We determined improvement of nasal symptoms in patients (nasal obstruction, headache, loss of sense of smell, rhinorrhea and posterior rhinorrhea) at the 3rd week and 3rd month after surgery compared to before surgery (p<0.05). We also determined improvement in the domains of SF-36 questionnaire (general healthy, physical functioning, problems of emotional role, social functioning, pain, vitality and mental health) at the 3rd week and 3rd month after surgery compared to before surgery (p<0.05). Control paranasal CT findings of patients at 6th months after surgery was also improved significantly compared to before (p<0.001). CONCLUSION: We determined improvement in all symptoms and quality of life for a short period of time after the surgical treatment performed on patients with nasal polyposis. The paranasal CT has an important place for diagnosis and treatment.