Are long-term auditory results following ossiculoplasty with bone cement as successful as early-middle period results?

PURPOSE: Bone-cement (BC) ossiculoplasty is one of the options to solve ossicular chain problems. Many authors reported successful results in the early or mid-follow-up period; however, there is no long-term result in the literature. We aim to evaluate long term results of BC ossiculoplasty. MATERIALS AND METHODS: Forty-eight patients who underwent BC ossiculoplasty as incudostapedial re-bridging by the same surgeon were invited to evaluation. Postoperative otomicroscopic examination was performed. Pre-operative and post-operative audiological results after longer follow up and graft success rate were noted. RESULTS: Fourteen patients came for control examination. The follow-up period was between 87 and 135 months (mean 102 months). None of the patients had graft failure. Ten patients had early postoperative follow-up results (between 10 and 52; mean 24 months). In the comparison of preoperative and early postoperative air-bone gap, there were significant differences in all frequencies while the comparison of preoperative and long-term postoperative results showed a significant difference only in 250 and 500 Hz. Early postoperative results were better than late with significant difference only in the 2000 and 4000 Hz. CONCLUSIONS: As reported by many studies, bone cement application provides a significant auditory improvement in the early postoperative period. The results of the present study showed that this early auditory success may decrease over time with a long-term follow-up. Further studies should be conducted with larger patient groups to clarify the long-term benefits of this treatment and possible causes for its deterioration.

Effectiveness of MESNA on the success of cholesteatoma surgery.

IMPORTANCE: It is important that chronic otitis media with cholesteatoma be treated successfully in patients to protect them from having repeated surgeries with related surgical co-morbidities and hearing loss. OBJECTIVE: To evaluate the effectiveness of MESNA usage on the residual cholesteatoma rates of the patients who underwent surgery due to chronic otitis media with cholesteatoma. DESIGN: Retrospective single-institution study of a prospectively collected database. SETTING: Tertiary University Hospital. PARTICIPANTS: Nine hundred and thirty-four patients underwent surgery due to chronic otitis media between September 2000 and March 2012 by the same surgeon. One hundred and forty-one cases out of 934 patients were selected who had cholesteatoma for the study. These randomly selected 141 cases were divided into two groups as follows: I. Forty-six cases were applied MESNA (Sodium 2-mercaptoethanesulfonate) intraoperatively, and II. Ninety-five cases were not applied MESNA intraoperatively. The cases that were followed-up at least one year were included in this study. INTERVENTION: MESNA (Ureomitexan, MESNA, Baxter oncology, Germany) was diluted with saline (20% MESNA and 80% saline) that was applied, and then a waiting period of approximately 5 min followed to start to dissect cholesteatoma matrix. MAIN OUTCOMES AND MEASURES: Residual cholesteatoma rates between intraoperative MESNA, a disulfide bond breaking chemical agent, applied and MESNA non-applied cases in the postoperative follow-up period were compared for the success of the surgery. RESULTS: MESNA was used in 46 patients out of 141 cases intraoperatively. Twenty-four of these patients underwent CWD (canal wall down), and twenty-two patients underwent CWU (canal wall up) mastoidectomy. For the other 95 subjects, 56 patients with CWD and 39 with CWU mastoidectomy, MESNA was not applied. Residual cholesteatoma rates were found to be significantly higher in MESNA non-applied group than MESNA applied group (p<0.05). Residual cholesteatoma rates between CWD and CWU mastoidectomy procedures were not statistically significant (p>0.05). CONCLUSIONS AND RELEVANCE: MESNA application that breaks disulfide bonds in the structure of the matrix in cholesteatoma surgery may assist the elimination of the disease, and increase surgical success by facilitating the elevation of the epithelium. Thereby, it causes a decrease in the possibility of remaining residual epithelium after surgery, which decreases the need for second-look surgery. TRIAL REGISTRATION: The retrospective research protocol was approved by the Inonu University Clinical Research Ethics Committee. REGISTRATION NUMBER: ………

Hearing loss can also be seen in patients with nonradiographic axial spondyloarthropathies as well as radiographic axial spondyloarthropathies.

Objectives: Hearing loss has been described in patients with radiographic axial spondyloarthropathies (R-AxSpA) but has not been studied in patients with non-radiographic axial spondyloarthropathies (NR-AxSpA); accordingly, the aim of the study was to compare hearing loss in patients with NR-AxSpA, R-AxSpA, and healthy individuals. Patients and methods: This cross-sectional observational study was conducted with 68 participants (30 males, 38 females; mean age: 39.8±7.4 years) between March 2021 and March 2022. Of the participants, 16 were patients with NR-AxSpA, 15 were patients with R-AxSpA, and 37 were healthy controls. Disease activity and radiological and audiological features were analyzed. The audiological assessment included pure-tone audiometric tests at octave frequencies of 250 to 8000 Hz and transient evoked otoacoustic emissions. Results: Hearing loss was found in three (8%) in the healthy group, five (31.3%) in the NR-AxSpA group, and 10 (66.7%) in the R-AxSpA group. The chi-square analysis showed a statistical significance (p=0.001). Values of audiometric tests yielded significant differences between the control and R-AxSpA group and also the control and NR-AxSpA group. For the air conduction studies, the statistical significance began at 1000 Hz in the R-AxSpA group. It was found that in the NR-AxSpA group, the statistical difference started in higher frequencies. The bone conduction audiometric studies were similar to air conduction studies. Transient evoked otoacoustic emission studies showed that the R-AxSpA group was significantly affected compared to the control and NR-AxSpA groups. There was no statistical difference between the control and NR-AxSpA groups. Conclusion: Both NR-AxSpA and R-AxSpA patients had hearing loss; however, in pure-tone audiometric tests, the abnormalities began in lower frequencies in the R-AxSpA group than in the NR-AxSpA group.

Hearing Loss and the Affecting Factors in Patients with Fibromyalgia.

OBJECTIVE: To find the frequency of hearing loss in newly diagnosed patients with fibromyalgia (FM), and the factors affecting it. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation and Department of Otorhinolaryngology Head and Neck Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Turkey, from March 2021 to November 2022. METHODOLOGY: Patients with FM and gender/age matched controls were compared with pure-tone audiometric (PTA), and transient evoked otoacoustic emissions (TEOE) tests after standardised otorhinolaryngologic assessment The subjects were questioned for NSAID uptake and scored with ASAS-NSAID score. RESULTS: There were 33 patients with FM and 32 healthy volunteers. Subjective tinnitus, dizziness, and hearing loss rate in the FM group were 12%, 18%, and 15%, respectively. PTA air and bone conduction studies yielded significant differences between the control and FM group (p<0.05). The statistical difference was pronounced in higher frequencies. TEOE tests showed the FM group had significantly lower scores when compared to the control group at 3000 Hz and 4000 Hz (p<0.05). The median ASAS-NSAID scores were 0 for the control group and 7.78 for the FM group (p <0.001). CONCLUSION: Patients with FM had high rate of audiometric hearing loss of the sensorineural type. The abnormalities were more prominent in the high frequencies but also present in the low frequencies. KEY WORDS: Fibromyalgia syndrome, Hearing loss, Audiometry, Ototoxicity, Central sensitisation.

Primary T-Cell Lymphoma of the Parotid Gland.

Primary malignant lymphomas of parotid gland are very rare. Most are B-cell lymphomas, and T-cell lymphomas are very rare. Unfortunately, fine needle aspiration biopsy is non-diagnostic. We, herein, present a case of a 51-year male, who presented with a large mass in the left parotid gland that had rapidly grown over a few months. As fine needle aspiration biopsy was non-diagnostic, we decided to take an incisional biopsy to disclose the pathology. The lesion was diagnosed as T-cell lymphoma after immunohistochemical examination of the specimens. Following 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT), the disease was staged as 'Stage I'. The patient received six sessions of cyclophosphamide, doxorubicin, vincristine and prednisone protocol as chemotherapy management. After the completion of chemotherapy, complete remission was achieved. In suspected cases, an incisional open parotid core biopsy should be considered for a definite diagnosis. As the treatment of lymphomas is not surgical, this approach avoids a parotidectomy, which in turn, avoids facial nerve complications. Key Words: T-cell lymphoma, Parotid gland, Malignant lymphoma, Incisional biopsy, Fine needle aspiration biopsy.

Evaluation of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios in Sudden Sensorineural Hearing Loss and Relationship with Hyperbaric Oxygen Therapy.

OBJECTIVES: This study aimed to evaluate the prognostic value of neutrophil/lymphocyte (N/L) and platelet/lymphocyte (P/L) ratios in sudden sensorineural hearing loss (SSNHL) and investigate the effect of combined corticosteroid medical treatment and/or hyperbaric oxygen (HBO) therapy on these values. MATERIALS AND METHODS: In this study, patients with SSHL at our tertiary center were examined retrospectively. A total of 60 patients with SSNHL and 30 healthy individuals as the control group were included. The patient and control groups were compared in terms of N/L and P/L rates. Furthermore, 60 patients were divided into 2 equal groups (n=30) on the basis of whether they received HBO in addition to combined corticosteroid treatment. RESULTS: The N/L and P/L rates were significantly higher in the patient groups than in the control group at the time of diagnosis and significantly decreased after treatment in the patient groups (p<0.05). It was observed that HBO therapy lowered the N/L and P/L rates more than the HBO-free group, but the statistically significant decrease was only in N/L ratio (p<0.05). CONCLUSION: The N/L and P/L rates were higher in the patient groups than in the control group, and there was also a significant decrease in the 2 values after treatment. This was an important finding showing that SSNHL has a possible underlying inflammatory and vascular (ischemic) condition. We also found that the higher the P/L ratio, the lower the recovery rate from hearing loss. This finding suggests that the P/L ratio can be an important prognostic indicator in patients with SSNHL.

Efficacy and Safety of Intranasal Medical Management in Pediatric Patients with Idiopathic Recurrent Epistaxis.

OBJECTIVE: The goal of the study was to verify the efficacy and safety of topical medical treatment in idiopathic recurrent pediatric epistaxis patients by intranasal usage of both an antimicrobial and a moisturizing agent as a first-step management modality. METHOD: Sixty-seven out of 326 pediatric patients with idiopathic recurrent epistaxis selected on a chart review of follow-up were enrolled in the study. The study was designed as an analysis of two groups: one group included 35 individuals (52.2% of the total cohort) having a hyperemic nasal mucosa and the second group included 32 individuals (47.8% of the total cohort) having a hypervascular nasal mucosa on physical examination before treatment. RESULTS: The study was performed with a total of 67 children (age range 3-17 years) including 36 males (53.7% of total cohort) and 31 females (46.3% of total cohort). The mean age was 9.78±4.09 years. There was not any statistically significant difference between the groups in terms of age, duration of follow-up and recurrence time of epistaxis (p>0.05). Recurrence of epistaxis was seen in 22.9% (8/35) of hyperemic nasal mucosa group and in 34.4% (11/32) of hypervascular nasal mucosa group (p>0.05). CONCLUSION: We advise the use of both an intranasal antimicrobial ointment and a mucosal moisturizing gel as an effective, noninvasive and easily applicable medical treatment option for pediatric patients with idiopathic recurrent epistaxis before more invasive methods of epistaxis control.

Risk Factors for Lingual Nerve Injury Associated With Suspension Laryngoscopy.

PURPOSE: This prospective study was designed to identify risk factors for lingual nerve injury as a complication of suspension laryngoscopy. METHODS: Fifty-six adult patients (19 females and 37 males) who underwent microlaryngeal surgery (MLS) using the suspension laryngoscopy procedure under general anesthesia at our otorhinolaryngology department between January 2016 and January 2018 were enrolled in this study. All operations were performed using only a cold-steel microlaryngeal surgical set, and operations using laser and radiofrequency energy were not included. Unilateral or bilateral paresthesia, numbness of the tongue, and/or a change in taste sensation (dysgeusia) were considered to indicate lingual nerve injury. RESULTS: Operation time and difficulties during intraoperative intubation and/or suspension of the larynx were major risk factors for lingual nerve injury following suspension laryngoscopy ( P = .015 and P = .011, respectively). Difficulties in preoperative flexible fiberoptic examination and intraoperative laryngeal compression were not found as risk factors, and the associations were not significant. Additionally, females showed a higher complication rate of lingual nerve injury following suspension laryngoscopy than males. CONCLUSION: From a medical-legal standpoint, although lingual nerve injury is not a life-threatening complication, it is important to inform patients, especially those expected to undergo long-duration surgery.

Assessment the long-term effects of septoplasty surgery on olfactory function.

OBJECTIVES: This research aimed to evaluate pre-operatively and post-operatively the olfactory function of patients who had undergone surgery in our clinic for chronic nasal blockage via the Connecticut Chemosensory Clinical Research Center (CCCRC) smell test. METHOD: Thirty-seven patients (24 females, 13 males) were enrolled in this study. All had undergone surgery in our clinic due to chronic nasal blockage (not for smell dysfunction), having been diagnosed with septal deviation in conjunction with concha bullosa and/or inferior turbinate hypertrophy. This is a prospective study without a control group. The mean age was 33.74 ± 8.98 (range =19-54). All of the operations were performed under general anesthesia. CCCRC smell tests were performed on every patient before the operation and at post-operative 1st week, 6th week, 6th month, and 1st year. RESULTS: In this study, we found that septoplasty, in conjunction with middle concha surgery and/or inferior concha radiofrequency, did not affect the olfactory function negatively. CONCLUSION: Although nasal surgery has the potential to affect the smell function negatively, it was found that olfactory function was not affected after the surgery during a considerably long follow-up period. Moreover, an improvement in smell function was detected at post-operative 6th month and 1st year.

Comparison of the effects of radiofrequency ablation and microdebrider reduction on nasal physiology in lower turbinate surgery.

OBJECTIVES: This study aims to compare the effects of radiofrequency ablation and microdebrider reduction in lower turbinate surgery on nasal physiology. PATIENTS AND METHODS: Between January 2009 and March 2010, 40 patients with the complaint of nasal obstruction, who were diagnosed with lower turbinate hypertrophy, were randomly assigned into two groups to undergo either radiofrequency (group 1, n=20) or microdebrider (group 2, n=20) treatments. Nasal obstruction, the grade of turbinate hypertrophy and other symptoms were evaluated with subjective nasal obstruction scale and anterior rhinoscopy before the operation, and three days, seven days, four weeks, and eight weeks after the surgical intervention. RESULTS: The patients in group 2 had a significantly greater symptomatic improvement based on subjective nasal obstruction scale (SNOS) scores than the patients in group 1 (p<0.01). Acoustic rhinometry (ARM) measurements without decongestant application showed significant increase in postoperative MCA2 (Minimum Cross-sectional Area/cm2 2) and Vol 2 (Volume/cm3 2) (p<0.01), while there was no significant change in MCA1 (Minimum Cross-sectional Area/cm2 1) and Vol 1 (Volume/cm3 1). There was no statistically significant difference between the two groups with respect to ARM and anterior rhinoscopy (AnR) parameters (p>0.05). CONCLUSION: Based on these results, both radiofrequency ablation and microdebrider reduction may be considered as minimally invasive, straightforward, and reliable methods that provide sufficient airway passage without disruption of the nasal physiology.

Bilateral hypopharyngeal perforations caused by penetrating trauma to the neck.

External laryngeal trauma is a relatively rare-encountered and sometimes life-threatening emergency condition. Recognition of laryngeal injury related to either blunt or penetrating trauma is important for both initial preservation of life as well as long-term airway and vocal function. Treatment options include medical management with observation and open surgical treatment with or without tracheotomy. We, herein, describe a 23-year-old male case who sustained external penetrating trauma to lateral aspect of neck. The etiology, clinical manifestations, investigation modalities and management of penetrating neck trauma were discussed in the light of the literature data.

Papillary Thyroid Microcarcinoma with a Large Cystic Dilated Lymph Node Metastasis to the Neck Mimicking a Branchial Cleft Cyst: A Potential Pitfall.

Lateral cervical cystic mass in a young adult very rarely could be a first sign of an occult thyroid papillary microcarcinoma metastasis. In this paper, we presented a 37-year-old male patient whose preoperative 6 cm left lateral cervical cystic mass was initially diagnosed as branchial cleft cyst, but then the postoperative histopathological examination of the mass was revealed as papillary thyroid carcinoma metastasis. Preoperative fine needle aspiration biopsy was relevant with a branchial cleft cyst. In the left thyroid lobe there were 3 solid nodules with 4, 6, and 12 mm dimensions, respectively. One of the nodules had malignant well-differentiated cells diagnosed after fine needle aspiration biopsy. After total thyroidectomy, histopathologic evaluation of biopsy material's showed papillary thyroid microcarcinomas. This case indicates that especially in a young adult lateral cervical cystic mass should be carefully considered preoperatively for the possibility of metastatic occult thyroid carcinoma, especially for papillary carcinoma in differential diagnosis, and evaluation of the thyroid gland should be taken into account.