European Position Statement on Diagnosis, and Treatment of Meniere's Disease.

Meniere Disease keeps challenges in its diagnosis and treatment since was defined by Prosper Meniere at the beginning of 19th Century. Several classifications and definition were made until now and speculations still exist on its etiology. As the etiology remains speculative the treatment models remain in discussion also. The European Academy of Otology and Neurotology Vertigo Guidelines Study Group intended to work on the diagnosis and treatment of Meniere's disease and created the European Positional Statement Document also by resuming the consensus studies on it. The new techniques on diagnosis are emphasized as well as the treatment models for each stage of the disease are clarified by disregarding the dilemmas on its treatment. The conservative, noninvasive and invasive therapeutic models are highlighted.

Epley maneuver and the head autorotation test in benign paroxysmal positional vertigo.

The head autorotation tests can be affected with the dynamic changes within the semicircular canals caused by benign paroxysmal positional vertigo (BPPV). The vestibular autorotation test is a method of examining the VOR (especially the VOR that develops at higher frequencies like those that occur in the everyday environment). Twenty patients who had been diagnosed as having posterior semicircular canal BPPV were evaluated with head autorotation tests before and after the treatment maneuver. The head autorotation tests were performed just before the use of the Epley maneuver and after the resolution of symptoms and the typical nystagmus pattern. The mean gain values for horizontal rotation tests during the pre-treatment period were 0.823, 0.844, and 0.840 for the frequencies 1, 2, and 3 Hz, respectively. The mean gain values increased by 0.095 (95% confidence interval) with Epley's maneuver. But this difference difference between the pre-treatment and post-treatment values was not statistically significant. All patients were also evaluated with vertical active tests. The differences between the pre-treatment and post-treatment values were not statistically significant in the vertical autorotation group. The phase values were within normal range in the horizontal and vertical rotation tests and remained so after the Epley maneuver. The stimulation of the VOR caused by BPPV did not affect gain and phase values to a statistically significant degree, and the values noted after the resolution of the patient's symptoms improved slightly but without statistical significance.

Endoscopic endonasal-transantral surgery for an isolated orbital floor blow-out fracture in a pediatric patient.

Orbital floor blow-out fractures occur due to blunt trauma causing displacement of orbital contents to the maxillary sinus while the orbital rim is intact. Surgical repair of these fractures includes transantral, transorbital, or endoscopic endonasal approaches with or without implant use. We report a 12-year-old boy who presented with diplopia after blunt trauma to the head while playing football. Computed tomography revealed a left isolated orbital blow-out fracture. The patient was treated by a combined endoscopic endonasal-transantral approach and stability was restored with a urethral balloon catheter following endoscopic reduction of the fracture. Healing of the orbital floor was confirmed by an early computed tomography scan. This technique restores eye volume and function without the use of external incisions or implants.

[Comparison of patients undergoing functional endoscopic sinus surgery combined with septoplasty or septorhinoplasty]. / Fonksiyonel endoskopik sinüs cerrahisi ile eszamanli septoplasti veya septorinoplasti uygulanan hastalarin karsilastirilmasi

OBJECTIVES: We compared patients who underwent functional endoscopic sinus surgery combined with septoplasty or septorhinoplasty and evaluated the concurrent applicability of septorhinoplasty and endoscopic sinus surgery. PATIENTS AND METHODS: We retrospectively analyzed 145 patients (96 males, 49 females; age range 16 to 78 years) who underwent endoscopic sinus surgery in conjunction with septoplasty or septorhinoplasty. The two patient groups were compared with respect to demographic characteristics, systemic diseases, allergy histories, the presence of nasal polyposis, preoperative paranasal sinus tomographies, Lund-Mackay scores, surgical procedures, operation times, and complication rates. RESULTS: Patients who underwent septorhinoplasty were younger than those undergoing septoplasty. There were no significant differences between the two groups in terms of paranasal sinus tomography scores, allergy histories, systemic diseases, and complication rates (p>0.05). The number of patients with nasal polyposis was significantly greater in the septoplasty group (p<0.05). Septorhinoplasty in conjunction with endoscopic sinus surgery required a significantly longer operation time (p<0.05). CONCLUSION: Complications and the severity of sinus pathologies were similar in the two groups. Concurrent applications of septorhinoplasty and endoscopic sinus surgery significantly increase operation time.

Six cases of Forestier syndrome, a rare cause of dysphagia.

Dysphagia is a common presenting complaint in otolaryngology practice, and there are many causes. Forestier syndrome is a rare cause of dysphagia. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) syndrome or vertebral ankylosing hyperostosis. Forestier syndrome consists of anterolateral perivertebral ligament calcification. It was first described by Forestier and Rotes-Querol in 1950; diagnosis is primarily radiological and the etiology is unknown. In addition to dysphagia Forestier syndrome has been reported to cause laryngeal stridor, dyspnea, snoring and hoarseness. Other important symptoms associated with Forestier syndrome are stiffness and pain in the back, pain related to tendinitis, myelopathy related to core compression associated with the ossification of the posterior longitudinal ligament, and pain related to vertebral complications such as fracture or subluxation. We report six cases of Forestier syndrome as an etiologic factor in dysphagia and present clinical and radiological findings.

[Dermatofibroma accompanied by perforating dermatosis in the auricle: a case report]. / Aurikulada dermatofibroma eslik eden perforan dermatoz: Olgu sunumu.

Although dermatofibroma is one of the most common soft tissue tumors, it is rarely seen in the face. Perforating dermatosis is characterized by papulonodules measuring 1-10 cm, with a central cup-shaped epidermal depression filled with a keratotic plug. An 82-year-old woman presented with a hyperkeratotic erythematous papular lesion, 0.8 cm in diameter, on the posterior side of the left auricle, showing no infiltration to the peripheral tissues. Total excisional biopsy was performed, which showed dermatofibroma accompanied by perforating dermatosis. No recurrence was detected during her follow-up. Our literature search did not yield any reported case of dermatofibroma accompanied by perforating dermatosis.

Choanal polyp originating from the nasal septum: a case report.

Almost all nasal polyps originate from the mucosa of the lateral walls of the nasal cavity or from the paranasal sinuses. A choanal polyp is the intranasal portion of a cyst that has arisen from the wall of the maxillary sinus near the ostium. Medially based polyps, such as those that arise from the nasal septum, are rare. The literature cites a wide range of incidence rates for polyps originating from this structure, but choanal extension of this type of polyp is extremely unusual. This report describes a polyp that arose from the superior aspect of the posterior nasal septum and extended through the choana into the nasopharynx. The histology of this choanal lesion was typical of nasal polyps, but the site of origin is rare. The ethiopathogenesis of nasal polyps with its common location remains controversial so it is difficult to speculate what mechanism triggered the development of this lesion on the nasal septum. Some form of local inflammation may have induced choanal polyp formation at this atypical site.

Factors that affect the outcome of open-technique procedures performed in the treatment of cholesteatoma.

OBJECTIVES: We evaluated the factors that have considerable significance on the outcome of open cavity procedures in the treatment of cholesteatoma. PATIENTS AND METHODS: The study included 66 patients (43 males, 23 females; mean age 47 years; range 21 to 69 years) who underwent surgery for cholesteatoma. Of these, 56 patients completed at least a five-year follow-up. RESULTS: Mucosal infections and granulation tissue formation occurred in seven patients (10%) in the early postoperative period. Retraction pockets developed in three patients (4%); of these, only one patient required excision because of deep localization. Drum perforations that occurred in two patients (3%) were repaired by myringoplasty. Revision surgery was performed in four patients (7.1%) due to residual cholesteatoma within a five-year follow-up. CONCLUSION: The height of the facial ridge was found as the most important factor related to a successful outcome of open-technique procedures. Other factors included the creation of a smooth mastoid cavity with round edges, removal of all diseased mastoid cells, and an extensive conchameatoplasty.

Auditory brain stem responses in the detection of brain death.

OBJECTIVES: We evaluated comatose patients by auditory brain stem responses (ABR) to determine the role of ABR in the diagnosis of impending brain death. PATIENTS AND METHODS: Sixty comatose patients in the intensive care unit were evaluated by brain stem evoked response audiometry. Correlations were sought between the absence or presence of ABRs and the presenting pathology, the Glasgow Coma Scale (GCS) scores, and ultimate diagnoses. RESULTS: The brain stem responses were totally absent in 41 patients. Presence of wave I could be obtained in only 10 patients. All the waveforms were found in nine patients; however, in eight patients the potentials disappeared as the GCS scores decreased to 3. Detection of wave I alone strongly suggested dysfunction of the brain stem. However, loss of wave I particularly in trauma patients aroused doubt as to whether the absence was associated with auditory end organ injury or brain stem dysfunction. CONCLUSION: The results suggest that evaluation of ABR may support brain death in a comatose patient (i) when wave I is present alone, (ii) the absence of wave I is accompanied by a documented auditory end organ injury, or (iii) when previously recorded potentials are no longer detectable.