Change in gene expression levels of GABA, glutamate and neurosteroid pathways due to acoustic trauma in the cochlea.

The characteristic feature of noise-induced hearing loss (NIHL) is the loss or malfunction of the outer hair cells (OHC) and the inner hair cells (IHC) of the cochlea. 90-95% of the spiral ganglion neurons, forming the cell bodies of cochlear nerve, synapse with the IHCs. Glutamate is the most potent excitatory neurotransmitter for IHC-auditory nerve synapses. Excessive release of glutamate in response to acoustic trauma (AT), may cause excitotoxicity by causing damage to the spiral ganglion neurons (SGN) or loss of the spiral ganglion dendrites, post-synaptic to the IHCs. Another neurotransmitter, GABA, plays an important role in the processing of acoustic stimuli and central regulation after peripheral injury, so it is potentially related to the regulation of hearing function and sensitivity after noise. The aim of this study is to evaluate the effect of AT on the expressions of glutamate excitotoxicity, GABA inhibition and neurosteroid synthesis genes.We exposed 24 BALB/c mice to AT. Controls were sacrificed without exposure to noise, Post-AT(1) and Post-AT(15) were sacrificed on the 1st and 15th day, respectively, after noise exposure. The expressions of various genes playing roles in glutamate, GABA and neurosteroid pathways were compared between groups by real-time PCR.Expressions of Cyp11a1, Gls, Gabra1, Grin2b, Sult1a1, Gad1, and Slc1a2 genes in Post-AT(15) mice were significantly decreased in comparison to control and Post-AT(1) mice. No significant differences in the expression of Slc6a1 and Slc17a8 genes was detected.These findings support the possible role of balance between glutamate excitotoxicity and GABA inhibition is disturbed during the post AT days and also the synthesis of some neurosteroids such as pregnenolone sulfate may be important in this balance.

Mild and moderate COVID-19 disease does not affect hearing function permanently: a cross-sectional study involving young and middle-aged healthcare givers.

PURPOSE: To assess the hearing function of patients with mild and moderate COVID-19. METHODS: The hospital staffs recovered from COVID-19 were included. The candidates who had an ear disease or progressive hearing loss prior to COVID-19, or having been hospitalised because of severe and critical COVID-19 were excluded. The age, sex, symptoms during COVID-19, and medications received for the disease were noted. The hearing thresholds (HT) of the participants who had an audiogram before having COVID-19 disease were recorded. A pure tone audiometry was conducted to all. The participants were classified into two groups; Group 1: participants who had an audiogram previously, Group 2: participants who didn't have an audiogram previously. The changes of the HTs of the participants in Group 1 were analyzed. The HTs of the participants in Group 2 were documented without any comparison. The HTs of all participants were also analyzed by classifying them into subgroups according to their symptoms during, and medications received for COVID-19. RESULTS: Fifty-four males and 47 females (18-59 years) were included. The participants' HTs in Group 1 (n = 31) did not change significantly at any of the frequencies after having COVID-19 (p > 0.05). The pure tone averages of the participants in Group 2 (n = 70) were below 25 dB and none of the participants reported worsening of their hearing permanently. The differences between the HTs of none of the subgroups were statistically significant (p > 0.05, p > 0.05). CONCLUSIONS: Mild and moderate COVID-19 and its treatments did not affect the hearing function permanently.

Use of Neutrophil, Eosinophil, Basophil, and Platelet to Lymphocyte Ratio to Predict Patient Satisfaction After Septoplasty Plus Inferior Turbinate Reduction.

AIM: Investigation of the predictive value of neutrophil, platelet, eosinophil, and basophil to lymphocyte ratio (NLR, PLR, ELR, and BLR) in evaluation of patients' satisfaction of septoplasty + inferior turbinate reduction operations. PATIENTS AND METHODS: Seventy-six patients who were operated because of nasal obstruction were enrolled in the study. They were invited to the hospital and asked to answer a modified nasal obstruction symptom evaluation (NOSE) survey to determine their degree of satisfaction. Patients were divided into 2 groups according to their modified NOSE survey results, dissatisfied and satisfied groups. The 2 groups were compared in terms of demographic data, surgery, and hematological values. In addition, correlation analysis was performed between NLR, PLR, ELR, BLR, and modified NOSE scores. RESULTS: There were 29 patients in the dissatisfied group and 47 patients in the satisfied group. Both groups were similar in terms of mean age, gender, surgery type, septal deviation type, smoking, hemoglobin, neutrophil, and white blood count (P > 0.05). There were significant differences between the 2 groups in terms of ELR and BLR (P < 0.05). In addition, there were negative and statistically significant correlations between modified NOSE scores and ELR and BLR. As ELR and BLR values increased, the satisfaction rate decreased. CONCLUSION: Eosinophil to lymphocyte ratio and BLR could be used to predict patient satisfaction after septoplasty and inferior turbinate reduction and for selection of patients.

Investigation of ambient-pressure absorbance characteristics of cartilage-grafted tympanic membranes.

OBJECTIVE: To investigate alterations in middle-ear mechanics after type 1 cartilage tympanoplasty by comparing the ambient pressure absorbance values of the perforated tympanic membrane, normal tympanic membrane and cartilage-grafted tympanic membrane. METHODS: Twenty patients diagnosed with non-suppurative chronic otitis media and 20 healthy controls were included. Pure tone audiometry and wideband tympanometry were performed once in the healthy controls and pre-operatively, one month and three months post-operatively in the patients. RESULTS: Using wideband tympanometry, the patients' three-month post-operative ambient pressure absorbance values were found to be similar to those of the healthy controls at low frequencies, while lower ambient pressure absorbance values were recorded at middle and high frequencies. Air-bone gap and ambient pressure absorbance values showed significant negative correlations at 1000 and 4000 Hz both pre- and post-operatively. CONCLUSION: Generally, the patients' ambient pressure absorbance values were significantly lower at middle and high frequencies than those of the healthy controls. Post-operative wideband tympanometry is a practical tool for investigating the effects of a repaired tympanic membrane on middle-ear dynamics.

The evaluation of ozone and betahistine in the treatment of tinnitus.

The aim of the study is to evaluate the effectiveness of ozone and betahistine treatments in the treatment of tinnitus. Sixty-eight patients were enrolled in this randomized, prospective controlled study. The ozone group consisted of 27, betahistine group consisted of 26 and control group consisted of 15 patients. The patients in ozone group received 10 sessions of ozone treatment via major autohemotherapy. Betahistine group received 48 mg/day betahistine tablets per oral for 3 months duration. The control group was followed up without any treatment given. The evaluation of tinnitus was made by tinnitus loudness and tinnitus handicap inventory (THI). The changes in findings from baseline to 3rd and 6th months were assessed, and the group results were compared. Comparison of the initial mean tinnitus loudness and 3 and 6 months after treatment in each of the three groups did not reveal a significant difference. The comparison between the groups in terms of the improvement of tinnitus loudness was not significant (p = 0.821). Comparison of the initial mean THI and 3 and 6 months after treatment revealed a significant difference in ozone and betahistine groups but not in the control group. When the delta (Δ) THI (the change of mean THI between the initial and 6th month) was compared between the groups, there was no significant difference. This randomized controlled study investigating the effects of ozone in tinnitus tries to shed light to a new method of treatment in tinnitus. The findings of the study does not provide enough evidence to support ozone and betahistine as a treatment for tinnitus and further research on the subject is necessary.

Approaches to subperiosteal orbital abscesses.

The purpose of this paper is to evaluate the epidemiology, clinical features, management and complications of subperiosteal orbital abscesses (SPOA)-a serious complication of rhinosinusitis. Retrospective data of 36 patients with SPOA secondary to acute rhinosinusitis from January 1998 to December 2011 were evaluated. Patients were analyzed in terms of age, gender, clinical features, CT findings, surgical procedures, microbiology, and complications. Twenty-three males and 13 females aged from 3 to 76 were evaluated. Nine patients-seven of which were under the age of 10-with small medial SPOA were treated only with medical management. Of the 13 with medial SPOA, transnasal endoscopic approach was performed for 10 and external approach for 3 to drain the abscess. As for the 12 patients with superior SPOA, 8 were treated via combined approach and 4 via external approach. The most common microorganisms were streptococci in children and anaerobes in adults. Total loss of vision developed in two adults with diabetes mellitus (DM). One patient with superior SPOA died due to frontal lobe abscess. Young children with small medial SPOA without significant ocular signs may successfully be managed medically. Surgical drainage is indicated for nonmedial abscesses, large medial abscesses with severe visual loss and with insufficient response to medical management. The risk of blindness from SPOA is higher in patients with DM.

Are the hearing and eustachian tube functions of the hot air balloon pilots disturbed?

OBJECTIVE: To evaluate the hearing and Eustachian tube functions (ETF) of hot air balloon (HAB) pilots, who are exposed to high altitude occupationally. MATERIALS AND METHODS: The study was designed as a cross-sectional controlled study. Thirty HAB pilots and 30 healthy volunteers were included. Pure tone audiometry and speech discrimination scores (SDS) were used to assess the hearing function. Pure tone average (PTA) was calculated using the hearing thresholds (HT) at the frequencies 500, 1000, 2000, and 4000 Hz. Tympanometry and automatic Williams test (ETF1) were conducted to assess the ETF of the participants. Eustachian Tube Dysfunction (ETD) was defined as the change of tympanometric peak pressure (TPP) at rest (P1) less than in 10 decapascals (daPa) with Valsalva (P2) and Toynbee (P3) maneuvers. Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) was also administrated. RESULTS: Mean ages of the participants were 32.03±8.12 and 32.33±9.47 years in the HAB and control groups, respectively (p = 0.865). HTs, PTAs, SDSs, P1, P2, P2-P1 and P1-P3 values were similar in the groups (p > 0.05). P3 values ​​in both ears were significantly higher in the HAB group compared to the control group (p = 0.018, p = 0.002). Positive correlations were detected between the duration of the experience of HAB pilots and their HTs at 4 kHz and 8 kHz (p < 0.05) The prevalence of ETD in at least one ear was 83.7% and in both ears was 43.3% in the HAB group, both of which were significantly higher than the control group (p = 0.001, p = 0.049). The ETDQ-7 scores were also higher in the HAB group compared to the control group (p < 0.001). CONCLUSION: Both the subjective and objective measures of ETF indicate that ETD is common among the HAB pilots. However, the hearing functions of those seem to be unaffected.

Can Wideband Tympanometry Predict the Prognosis of Otitis Media With Effusion?

Background and Objectives: This study aims to evaluate the capacity of wideband tympanometry (WBT) in predicting the prognosis of otitis media with effusion (OME). Subjects and Methods: Sixty-one ears with effusion and 30 healthy ears of children were enrolled. The patients were followed up monthly using WBT. After the completion of measurements, the ears were separated into four groups according to the duration of recovery; Group 1: Good prognosis (≤1-month, n=18), Group 2: Worse prognosis (>1-month, n=29), Group 3: Surgical (no recovery, n=14), and Group 4: Control (healthy ears, n=30). Tympanometric peak pressure (TPP), resonance frequency (RF), and absorbance levels were compared within and between the groups. Results: The TPP and RF values of the study group were lower than those of the controls (p<0.001). The ears with OME had lower absorbance measures than the controls at all frequencies; the differences were significant at 250, 500, and 1,000 Hz (p<0.001). However, at 2,000 Hz, the absorbance levels of the ears with OME were similar with those of the control group only in the good prognosis group (p>0.05). The receiver-operating characteristic analysis revealed that absorbance measures over 0.237 and 0.311 at 1,000 Hz and 2,000 Hz, respectively, have sensitivities and specificities over 70% for prediction of good prognosis, and the calculated odd ratio for these measures were 6 (p<0.05). Conclusions: WBT measurement is promising in predicting the recovery of OME in children.

Comprehensive evaluation of velopharyngeal function in myasthenia gravis patients.

PURPOSE: Hypernasality, which is a symptom of dysarthria, may be seen in patients with Myasthenia Gravis with bulbar symptoms. However, there is not enough evidence to show that these patients may have velopharyngeal dysfunction. This study investigates the features of velopharyngeal function in myasthenia gravis patients using objective and subjective measurement tools. METHODS: Ten adult myasthenia gravis patients with bulbar symptoms and ten adult myasthenia gravis patients without bulbar symptoms were recruited for this study. Ten healthy subjects were also included as the control group. The nasalance scores of the participants were determined using a nasometer. The degree and pattern of velopharyngeal closure were scored using flexible nasoendoscopy during speech, blowing, dry swallowing, and food swallowing. Perceptual hypernasality was assessed. RESULTS: Velopharyngeal dysfunction was detected in 50% of the myasthenia gravis patients with bulbar symptoms. Velopharyngeal dysfunction was not seen in myasthenia gravis patients without bulbar symptoms. The degree of velopharyngeal closure in patients with bulbar symptoms differed depending on the tasks being performed. No significant difference in velopharyngeal closure patterns was observed between the groups (p < 0.05). CONCLUSION: Myasthenia gravis patients with bulbar involvement may have velopharyngeal dysfunction. It is important to conduct a comprehensive evaluation to assess all aspects of the velopharyngeal function.

Acute Otitis Media and Facial Paralysis in an Infant with Aural Atresia: Management of a Rare Case.

Aural atresia is a congenital disease that is characterized by an embryologic developmental defect of the external auditory canal (EAC). There is an erythematous, bulging tympanic membrane by otoscope in physical examination of acute otitis media (AOM). Children with aural atresia experience AOM as children have normal anatomy. However, its diagnosis is hard due to the absence of EAC. Facial paralysis is an intratemporal complication of AOM. If this complication develops in a child with aural atresia and otitis media, it makes the condition even more complicated. A 10-month old child who had such a condition is presented in this paper.

Assessment of the Effectiveness of Transcranial Magnetic Stimulation in Subjective Tinnitus.

Introduction Increases in spontaneous activity in the neurons of the auditory cortex are presumed as the pathophysiology of tinnitus. Objective To investigate the effectiveness of transcranial magnetic stimulation (TMS) in the treatment of tinnitus. Methods A total of 62 patients between the ages of 22 and 74 with chronic subjective tinnitus were enrolled in the study. The inclusion criteria were normal findings on an otolaryngologic examination and normal ranges of complete blood count, routine biochemical parameter levels, thyroid function, air-bone gap on pure-tone audiometry, and middle-ear pressure and stapedial reflex on tympanometry. The patients were randomized into 2 groups: 40 patients were placed in the treatment for TMS (tTMS) group, and the rest (22 patients) were placed in the sham TMS group. The frequency and severity of the tinnitus, as well as the tinnitus handicap inventory (THI) score of each patient were measured before and one month after the treatment, and the values were statistically evaluated. Results We observed a statistically significant improvement in the tTMS group ( p < 0.05 and p < 0.05 respectively) regarding the THI and tinnitus severity scores. The sham TMS group showed no significant improvement in terms of the THI ( p > 0.05). However, the tinnitus severity showed a significant increase in this group ( p < 0.05). The comparison of differences in the changes in the THI and the tinnitus severity scores showed a significant statistical improvement in the tTMS group compared with the sham TMS group ( p < 0.05 and p < 0.05 respectively). Conclusion Transcranial magnetic stimulation was found to be effective in the treatment of tinnitus, and may be adopted as a treatment for tinnitus after further comprehensive studies.

The Bibliometric Analysis of the Studies Presented at the Turkish National Otorhinolaryngology Congresses in the Period 2009-2018.

OBJECTIVE: The aim of this study was to quantitatively and qualitatively analyze the abstracts presented at Turkish National Otorhinolaryngology Congresses in the years from 2009 to 2018. METHODS: Abstracts were defined and grouped according to their field of study, design, level of evidence, number of authors, the main institution in which they were held, and whether they were uni- or multi-centric. Frequency and percentage tables were prepared. RESULTS: In total, 5,463 studies, of which 1,431 (26.2%) were oral presentations and 4,032 (73.8%) were poster presentations were reviewed. The highest number of studies was in the field of otology and in the form of oral presentations (32%), and in the field of head and neck surgery in the form of poster presentations (37%). Fifty-seven percent of all studies were conducted in university hospitals, and 34% in Training and Research Hospitals. Eighty-three percent of oral presentations and 99% of poster presentations were clinical studies. The rate of experimental animal studies was 16% in oral presentations. The most commonly used design of orally presented clinical studies was descriptive (31%), whereas prospective randomized controlled design was the least common (3%). No study with a level 1 of evidence was found. The rate of oral papers presented with evidence levels 2, 3, 4, and 5 among all oral presentations were 22%, 13%, 11%, and 54%, respectively. CONCLUSION: The findings indicated that the abstracts were satisfactory in quantity, but overall scientific quality was not sufficient. The data obtained may serve as a basis for future studies, and follow-up studies may guide individuals and institutions that steer the Turkish ENT community.

Mean platelet volume, neutrophil- and platelet to lymphocyte ratios are elevated in vestibular neuritis.

AIM: To evaluate the alterations in inflammatory markers, NLR and PLR, as well as mean platelet volume (MPV) and the other parameters of complete blood counts (CBC) in adult patients with vestibular neuritis (VN). METHOD: Designed as a case control study. The records of the patients, who were hospitalized due to an acute onset vertigo, and diagnosed as VN, were analysed retrospectively. The complete blood count (CBC) measures of the patients were statistically compared with the measures of healthy subjects. The correlations between the length of hospitalization and the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were also analysed. RESULTS: One hundred four patients with VN and 138 healthy controls were included. MPV, white blood cell and neutrophil counts, NLR and PLR were significantly higher; while lymphocyte count was significantly lower in the VN group (p < 0.001). There were no correlations between the length of hospitalization and NLR or PLR. CONCLUSION: The elevations of NLR and PLR support the role of inflammation in VN. The high level of MPV indicates the possible role of the vascular thrombosis in the etiology of VN.

Effects of Dexmedetomidine Infusion During Sevoflurane Anesthesia on Otoacoustic Emissions.

BACKGROUND AND OBJECTIVES: Knowing the ototoxic potential of the agents used in medical treatments is important for the protection of hearing. Although we have knowledge regarding some effects of dexmedetomidine, which is an anesthetic-sparing drug, its influence over the hearing system has never been studied and is obscure yet. The aim of this study is to determine the effects of intravenous dexmedetomidine application during sevoflurane anesthesia on otoacoustic emissions (OAEs). SUBJECT AND METHODS: This prospective randomized study was performed on 60 patients (34 male, 26 female, mean age: 30.6±9.2 years) who were scheduled for an elective surgery under general anesthesia and the patients were enrolled and randomly divided into 2 groups. They received dexmedetomidine (Group D) or Saline (Group S) infusion during a standardized Sevoflurane anesthesia. Transient and distortion product OAEs were measured preoperatively and postoperatively (24th hour). OAE results were compared within and between groups. RESULTS: In group D postoperative OAEs were lower than preoperative OAEs and postoperative levels of group S, especially at low frequencies (p<0.05). CONCLUSIONS: Dexmedetomidine infusion affects the micromechanical function of cochlea especially in the low-frequency region. Dexmedetomidine should be carefully used during general anesthesia to avoid its probable harmful effects on cochlear micromechanics.

Assessment of the Effectiveness of Quercetin on Cisplatin-Induced Ototoxicity in Rats.

OBJECTIVES: This study aimed to evaluate the effect of quercetin on cochlear function and morphology, and its possible protective effect against acute cisplatin-induced ototoxicity in rats. MATERIALS AND METHODS: This prospective and controlled animal study was conducted on Wistar albino rats divided into four groups. Otoacoustic emission measures were performed three days after the first infiltration in Group 1 (saline), 2 (cisplatin), and 3 (quercetin). This interval was five days for Group 4 (cisplatin+quercetin). At the end of the study, the rats were decapitated with deep anesthesia, and histological changes in the cochleas were observed by light microscopy. RESULTS: Group 2 (cisplatin) revealed significant differences between the first and second measures in all frequencies. When compared to other group, the difference of the changes in Group 2 statistically significantly decreased, especially in higher frequencies. Morphologically, there were no acute changes in Group 1 and Group 3. Outer hair cell loss and the degeneration of stria vascularis and spiral ganglion were observed in both Groups 2 and 4; the damages in the latter were lesser. CONCLUSION: Quercetin does not have negative effect on cochlea, and it has protective effect on cisplatin-induced ototoxicity.

Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis.

INTRODUCTION: Mucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. OBJECTIVE: The aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. METHODS: Forty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. RESULTS: Patient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p<0.05). CONCLUSIONS: Unique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate.

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study.

OBJECTIVES: To identify the optimal pharmacological method of preparing patients for nasal endoscopy. METHODS: Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded. RESULTS: The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically. CONCLUSION: Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

The Role of Trace Elements in Tinnitus.

In this study, we aimed to investigate the role of three trace elements, namely, zinc, copper, and lead, in tinnitus by analyzing the serum level of copper and lead and both the serum and tissue level of zinc. Eighty patients, who applied to outpatient otolaryngology clinic with the complaints of having tinnitus, and 28 healthy volunteers were included. High-frequency audiometry was performed, and participants who had hearing loss according to the pure tone average were excluded; tinnitus frequency and loudness were determined and tinnitus reaction questionnaire scores were obtained from the patients. Of all the participants, serum zinc, copper, and lead values were measured; moreover, zinc levels were examined in hair samples. The levels of trace elements were compared between tinnitus and control groups. The level of copper was found to be significantly lower in the tinnitus group (p = 0.02), but there was no significant difference between the groups in terms of the levels of zinc, neither in serum nor in hair, and lead in serum (p > 0.05). The lack of trace elements, especially that of "zinc," have been doubted for the etiopathogenesis of tinnitus in the literature; however, we only found copper levels to be low in patients having tinnitus.

The Effect of Nystatin Solution on Otoacoustic Emissions in Rats.

OBJECTIVE: In patients with a perforated tympanic membrane, topically administered medication reaches the middle ear and thus creates a risk of ototoxicity. The aim of the present study was to evaluate the possible ototoxic effect of the antifungal medication nystatin when administered to the rat middle ear cavity. MATERIALS AND METHODS: Three groups (negative control, positive control, and study groups), each containing eight rats, were formed. Before the drug administration, distortion product otoacoustic emissions were recorded in both ears of each rat. Saline (0.09% NaCl), gentamycin, and nystatin solutions were transtympanically injected into the middle ear cavities of the negative control, positive control, and study groups, respectively, for five consecutive days. Seven days after the last infiltration, the control otoacoustic emission was measured, and the data of the 2, 3, 4, 6, 8 kHz frequencies were statistically analyzed. RESULTS: There were no significant changes between the 1st and 2nd measures in the negative control group (0.09% NaCl) (p>0.05), whereas there were significant changes between the 1st and 2nd measures in the positive control group (gentamycin) and study group (nystatin) (p<0.05). CONCLUSION: Ototopical medications carry a risk of ototoxicity in patients with perforated ear drums. In the present study, it was shown that nystatin, an antifungal that can be ototopically used in the treatment of otomycosis, may cause a decrease in otoacoustic emissions in rats when administered into the middle ear cavities.

Thyroid leiomyosarcoma: presentation of two cases and review of the literature.

INTRODUCTION: Leiomyosarcoma is a tumor which is rarely seen in the thyroid gland. The diagnosis may be difficult and the treatment is controversial. OBJECTIVE: The objective of the study is to review the literature about a rare malignant disease of the thyroid gland which has high mortality. METHODS: Two cases of thyroid leiomyosarcoma are presented and the previous 23 cases in the current literature are reviewed. RESULTS: A total of 25 cases of thyroid leiomyosarcoma are reviewed; the most common complaint was rapidly growing anterior neck mass, and ten of the 25 patients had distant metastasis at the initial admission. Fifteen of the 25 patients died with the disease in the first 12 months after the diagnosis. CONCLUSION: The differential diagnosis of thyroid leiomyosarcoma is important and should be performed with other malignancies of the gland, especially with anaplastic carcinoma. The prognosis is poor and there is no consensus regarding the treatment.