The role of high frequency tympanometry in newborn hearing screening programme.

BACKGROUNDS AND OBJECTIVE: The hearing assessment of the newborns ideally should detect both middle and inner ear functions. The aim of this study is to control the association between otoscopic evaluation, multifrequency tympanometry and TEOAE results. METHODS: Fifty new-borns otherwise healthy were tested after the otolaryngological evaluation by 226 and 1000 Hz tympanometries and transient evoked otoacoustic emissions (TEOAE's). The study was performed in three steps and 17 babies that could not pass from the first step they were tested in the second step with the same tests (226 Hz and 1000 Hz tympanometry and TEOAE) The babies that could not pass from the second step were evaluated by multifrequency tympanometries, TEOAE and acoustic brainstem responses (ABR) at the third step. RESULTS: The association between the results obtained from otoscopic evaluation, multifrequency tympanometry and TEOAE were assessed. We found that 1000 Hz tympanometry results were more sensitive and gives more correlated with TEOAE and otoscopic evaluation. CONCLUSIONS: Multifrequency tympanometry can detect the middle ear pathologies of the infants sensitively and should be a part of neonatal hearing screening test battery.

Serum paraoxonase, arylesterase activity and oxidative status in patients with obstructive sleep apnea syndrome (OSAS).

INTRODUCTION: The aim of this study was to evaluate the serum paraoxonase (PON), arylesterase activities, lipid hydroperoxide (LOOH), sulfhydryl (-SH), and ceruloplasmin (Cp) levels, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) in adults with obstructive sleep apnea syndrome (OSAS) and to determine whether these oxidant and antioxidant levels can be used as OSAS markers. The results were compared with measurements from healthy control subjects. METHODS AND METHODS: This study was a prospective, controlled trial including 26 OSAS patients and 35 healthy controls (61 subjects total). Peripheral venous blood samples were taken from the OSAS patients and from the healthy volunteers. The serum PON, arylesterase activities LOOH, -SH, Cp, TAS, TOS, and OSI levels were measured. RESULTS: LOOH and Cp levels were higher in the OSAS group than in the control group (p < 0.01). The -SH levels were lower in the OSAS group than in the control group (p < 0.01). The PON and arylesterase enzyme activity levels were lower in the OSAS group than in the control group (p < 0.05). The TOS and OSI levels were significantly higher in the OSAS group (p < 0.01), while their TAS levels were significantly lower (p < 0.01) compared with the control group. CONCLUSIONS: Patients with OSAS have increased systemic oxidative stress and reduced levels of circulating antioxidant enzymes. Oxidative stress appears to be an underlying condition associated with OSAS.

Relation between actinomycosis and histopathological and clinical features of the palatine tonsils: a comparative study between adult and pediatric patients.

OBJECTIVE: To find out the incidence of actinomyces in the palatine tonsil of the adult and pediatric patients, and evaluate our results relevant to the clinical diagnoses and histopathological features of tonsillectomy specimens. METHODS: The medical records of 1820 tonsillectomies, which were performed in the Department of Otolaryngology between 1987 and 2002 were retrospectively reviewed. The paraffin embedded specimens of the patients were also obtained for histopathologic assessment, and Hematoxylin-Eosin stained sections re-evaluated mainly for cryptitis and actinomycosis. RESULTS: There was actinomyces in 122 (6.7%) of 1820 patients, of whom 62 were adult and 60 were pediatric patients. That is, actinomyces was present in 62 (10.9%) of 568 adult patients, and 60 (4.8%) of 1252 pediatric patients. The rate of actinomyces was significantly higher in adults than children (p < 0.01). There was no correlation between the clinical diagnoses and the histopathologic parameters assessed (p > 0.05). On histopathology, the cryptitis was encountered in 53 (85%) of 62 adult patients and 47 (78%) of 60 pediatric patients with actinomyces (p > 0.05). The rate of cryptitis was significantly higher in the presence of actinomyces both in adult and pediatric patients (p < 0.05). CONCLUSION: There was no correlation between the clinical diagnosis of tonsillar disease and the presence of actinomycosis both in adult and pediatric patients. Histopathologic findings of adult and pediatric tonsillectomy material was similar except for the higher rate of actinomycosis in the adults than in children. However, cryptitis was a substantial finding in the presence of actinomycosis. Based on the significant association of cryptitis with actinomycosis, cyptitis can be considered a histopathologic indicator for tonsillar actinomycosis.

Influence of the relapse and remission periods on hearing status in children with minimal change nephrotic syndrome.

OBJECTIVE: Minimal change nephrotic syndrome (MCNS) is characterized by the onset of NS (Nephrotic Syndrome) without systemic disease, hypocomplementemia, or other serious signs of renal disease. Hearing status is not very well known in MCNS. Our objective was to address this question and to find out remission and relapse periods of the syndrome would affect the hearing of the patients. METHODS AND PATIENTS: Otologic status of 26 children with clinical MCNS was investigated in relapse and remission periods using audiometry and tympanometry. The pure tones that were obtained at the frequencies 250, 500, 1000, 2000, 4000 and 6000 Hz were noted. Pure tone averages (PTAs) were calculated at 500, 1000, 2000 and 4000 Hz frequencies. RESULTS: In both remission and relapse periods, PTA of the patients did not change and was 13 dB. The frequency specific pure tone results were not significantly different between the right and left ears of the patients as well as between the remission and relapse periods (p > 0.05). In the relapsing and remission periods, type A tympanogram was encountered in 86.4% and 92.3% of the ears, respectively. Type B tympanogram was encountered in 11.5% and 3.8% of the ears in the relapsing and remission periods, respectively. Type C tympanogram was encountered in 3.8% of the ears both in the relapsing and remission periods. Differences between the tympanometry results were not significant (p > 0.05). CONCLUSION: MCNS in childhood is not associated with an alteration in the hearing status, both in remission and relapse periods of the disease.

Use of the auditory brainstem response testing in the clinical evaluation of the patients with diabetes mellitus.

The objective of the study was to assess whether a relationship exists between the auditory brain stem response (ABR) results and diabetes mellitus with and without complications. In the clinical and audiometry laboratory settings, diabetic patients with and without complications (retinopathy and/or nephropathy) were examined using ABR testing, and the results were interpreted for their applicability in clinical practice. Fifty-nine patients with diabetic retinopathy or nephropathy (study group) and 20 diabetic patients without any known diabetic complication (control group) were assessed with audiometry and ABR testing. ABR revealed that the absolute latencies and interwave intervals of the waves I through V were prolonged significantly in the study group when compared to the control group. The amplitudes of waves I through V were diminished in the study group when compared to the control group, but a statistical significance was present only for wave V amplitude. Quantitative (wave I to wave V amplitude ratio) and qualitative analyses of the ABR waves showed abnormal waveforms in the study and control groups by 55.2 and 27.6%, respectively. There is a brain stem neuropathy in diabetes mellitus which can be assessed with ABR testing. The likelihood of encountering a diabetic complication increases as the ABR results become abnormal.

Cycline-dependent kinase inhibitor, p27 (KIP1), is associated with cholesteatoma.

OBJECTIVE: Cyclin-dependent kinases (CDKis) can arrest the cell cycle, which in turn inhibits the cell proliferation. P27 (KIP1) is a CDKi and acts as a tumor suppressor gene. In this study, we aimed to investigate the role of p27 CDKi in cholesteatoma, a disease characterized by the presence of hyperproliferative squamous epithelium. STUDY DESIGN: Immunohistochemical staining of 15 cholesteatoma and 18 control ear canal skin samples, which were taken intraoperatively, was performed for p27 positivity. METHODS: The monoclonal antibodies to p27 were used for immunohistochemical staining of the sections. The streptavidin-biotin horseradish method was used. The number of cells staining positive for p27 was calculated, and the intensity of p27 positivity was graded. RESULTS: P27 positivity was obtained in 9 (50%) of 18 skin tissues. In the cholesteatoma tissues, p27 positivity was found only in 2 (13.3%) tissue samples. The difference between the groups were statistically significant (P =.03). The mean numbers of p27 positivity were 11.8 +/- 15.5 and 1.4 +/- 3.8 (mean +/- standard deviation) in the skin and cholesteatoma samples, respectively. This difference was also statistically significant (P =.02). The p27 results of primary and secondary cholesteatoma samples were not significantly different (P =.3). The results of p27 were not related to the gender of the patients (P =.8). CONCLUSION: P27 is involved directly or indirectly in the occurrence of cholesteatoma. Alterations of p27 levels in keratinocytes can influence the proliferative state of the keratinocytes. Altered p27 levels in cholesteatoma may suggest a molecular pathology in cholesteatoma. The search for significance of CDKis seems promising to better understand the pathogenesis of cholesteatoma.

Significance of Fas protein in squamous cell carcinoma of the larynx.

The purpose was to elucidate the clinical significance of Fas protein in laryngeal squamous cell carcinoma (LSSC). Medical records of 30 patients who were operated for LSCC between 1991 and 1997 were reviewed, and histopathological and immunohistochemical studies of the archival tumor tissues were performed. Conventional histopathology included tumor grading, mitotic counting (MC) and status of the cervical lymph nodes. The monoclonal antibodies to Fas (DAKO M 3554) and nm23 (DAKO A0096 Lot 035) proteins were used for immunohistochemical staining. Streptavidin-Biotin, horseradish method was used. Positive staining for both Fas and nm23 was obtained in 27 (90%) tumor samples. There was no correlation between neck metastasis and Fas positivity (r = 0.126, p = 0.505 and chi2 = 0.062, p = 0.996, respectively). Fas positivity did not correlate to grade (r = 0.282, p = 0.130), tumor size or T (r = 0.0457, p = 0.810, chi2 = 0.0.018, p = 0.999) or laryngeal site of involvement (chi2 = 0.0937, p = 0.992). However, a correlation was found between Fas and MC (r = 0.482. p = 0.007). There was also a correlation between Fas and nm23 positivity (r = 0.614, p < 0.0001). Fas protein expression has no prognostic value in LSCC, because the Fas values do not correlate with grade, stage or nodal status of neck. However, 90% of LSCCs expressed Fas protein. Understanding the functional status of the Fas receptor proteins may lead to development of new therapeutic options for LSSC in the future.

The predictive value of auditory brainstem responses for diabetic retinopathy.

OBJECTIVE: The purpose was to find out whether there is a relationship between the central nervous system involvement and retinopathy in diabetes mellitus. STUDY DESIGN: In a multidisciplinary clinical study, diabetic patients with and without retinopathy were examined utilising auditory brainstem response (ABR) testing, and the results were interpreted from clinical and pathophysiological point of view. PATIENTS AND METHODS: Thirty-three diabetic patients with retinopathy (study group) and 20 diabetic patients without retinopathy (control group) were included. Audiometry and ABR testing were made. The results of both groups were compared for ABR parameters. RESULTS: Audimetric results of the study and control groups were similar. In the study group, ABR testing revealed prolonged absolute and interpeak latency of the waves. The difference was significant for I-III interval (P<0.01). The amplitudes of the waves were similar in both groups and wave V amplitude was significantly diminished in the study group. Abnormal waveforms were recorded by 40 and 12.5% in the study and control groups, respectively. CONCLUSION: Retinopathy is accompanied with lower brainstem disintegration. Microangiopathy is the possible mechanism that is involved in the occurrence of retinopathy and brainstem neuropathy. ABR can help diagnose retinopathy. Better understanding the role of ABR in diagnosis and early detection of retinopathy in diabetic patients needs further study.

Eosinophilic granuloma of the temporal bone.

Histiocytosis X or Langerhans cell histiocytosis (LCH) is a disease that possesses three less distinctive and overlapping states called eosinophilic granuloma (EG), Hand-Schuller-Christian (HSC) disease and Letterer-Siwe (LS) disease. EG is the least severe and localized form of all LCHs and possesses the best prognostic result. A high index of suspicion is required to diagnose the EG, especially when an ear disease is refractory to medical treatment. Early detection is important to manage the EG properly and to minimize the complications or sequels of treatment. Definitive diagnosis of histiocytosis is made by histopathological means and immunohistochemical detection of S-100 and CD1 antigens in the tissue samples. And differential diagnosis of the subgroups is made according to the clinical manifestations such as visceral organ or bone involvement. Surgical excision, radiotherapy and chemotherapy, either alone or in combination, are the main treatment options.

Management strategy of mycobacterial cervical lymphadenitis.

The objectives of this study were to investigate the typical clinical presentation, diagnosis and treatment of mycobacterial cervical lymphadenitis (MCL). Medical records of 87 patients who were treated for MCL were retrospectively reviewed. Definitive diagnosis of MCL was made when a neck mass persisted for several weeks or months and one or more of the following was obtained: (1) positive mycobacterial cultures from biopsy material; (2) Positive mycobacterial staining of biopsy material; (3) Granulomatous inflammation and caseating necrosis on histopathological examination of biopsy material. Clinical findings were reviewed prior to treatment. The treatment included standard antituberculous medications followed by surgery in which either total excision or selective nodal dissection of the cervical lump was made. Follow-up results are presented. The chief complaint was a cervical mass that was localized mostly to the posterior cervical or submandibular regions. A fistula formation was encountered in 11.5 per cent. All patients recovered from MCL by combined antituberculous drug and surgical treatments. Clinical presentation of the disease and histopathological assessment are important in the diagnosis of MCL as well as in the differential diagnosis of tuberculous and nontuberculous MCL. Utilizing the combined medical and surgical treatment options, both tuberculous and non-tuberculous cervical adenitis can be treated successfully.

Assessment of migraine-related cochleovestibular symptoms.

The objective was to assess the cochleovestibular symptoms in migraine. Therefore, a questionnaire form was prepared to record the data obtained from 20 migraineurs. All patients were assessed with audiometry, bithermal caloric testing and auditory brainstem response testing (ABR) between the migraine attacks, and 8 of them were also assessed during the attacks. Dizziness (30%) was the most common symptom that was followed by vertigo (25%) and tinnitus (20%). All patients had hearing within normal limits. Positional test (Hallpike maneuver) was positive in 2 (10%). Bithermal caloric testing revealed canal paresis in 3 (15%) patients. ABR results were normal in 13 patients. Seven patients (35%) had abnormal ABR results. Four of them (20%) had elongation in the absolute wave latencies (wave I, III and V) and normal IPLs of wave I-III, III-V and I-V. Three (15%) patients had elongation in the absolute wave latencies as well as in the IPLs of wave I-III, III-V and I-V. In conclusion, cochleovestibular symptoms can be seen in migraineurs. The test results between and during attacks are similar. The subjective cochleovestibular symptoms did not correlate with the objective tests performed (audiometry, ABR and caloric testing).

Clinical and histopathological correlates of the proliferative activity in squamous cell laryngeal carcinoma.

OBJECTIVES: To elucidate the clinical and histopathological significance of the proliferative activity as determined by PCNA and Ki67 levels and mitotic counting (MC) in laryngeal squamous cell cancer (LSCC). STUDY DESIGN: An analysis of clinical, histopathological and immunhistochemical (PCNA0 and Ki67) results of 28 patients, who were treated for LSCC, was made. METHODS: Clinical data of the patients were reviewed and corresponding archival paraffin embedded tissue samples were obtained. Histopathological studies and MC were performed, and PCNA and Ki67 positivity was assessed. RESULTS: There was no association between the mean values of the proliferative markers, and N stage and T stage of the patients as well as laryngeal site of involvement (p > 0.05). There was a correlation between the proliferative indicators and tumor grade (p < 0.05). A correlation was also encountered between the PCNA, Ki67 and MC values (p = 0.02). CONCLUSION: The proliferative markers studied are not reliable indicators for the presumptive diagnosis of occult neck metastasis. They may be used as complementary tools to the conventional histopathologic grading systems to assess the tumour differentiation in LSCC.

Malignant mixed tumor of the larynx: a case report.

Malignant mixed tumour (MMT), which is a salivary gland tumour, is the malignant form of pleomorphic adenoma. Although the tumour can also originate from the minor salivary glands throughout the submucosa in the head and neck region, laryngeal involvement is quite rare. An additional case of laryngeal MMT presented in a forty-five year old man, and the diagnostic, immunohistochemical (S-100, actin, vimentin, epithelial membrane antigen) and therapeutic procedures were presented.

Management of incus long process defects: incus interposition versus incudostapedial rebridging with bone cement.

OBJECTIVE: This study aimed to compare the hearing results of incus interposition and bone cement ossiculoplasty in patients with incus long process defects. MATERIALS AND METHODS: Ninety-nine patients with incus long process defects were included. Incus interposition was performed in 49 patients (group 1) and bone cement ossiculoplasty was performed in 50 patients (group 2). Group 1 included 29 female and 20 male patients, with a mean age ± standard deviation of 29.43 ± 12.5 years (range, 8­58 years). Group 2 comprised 32 female and 18 male patients, with a mean age ± standard deviation of 29.1 ± 14.89 years (range, 8­67 years). RESULTS: The mean hearing gain ± standard deviation was 15.2 ± 9.01 dB in group 1 and 19.36 ± 9.08 dB in group 2. Hearing gain was significantly greater in the bone cement group than in the incus interposition group (p = 0.0186). Successful hearing results (i.e. air­bone gap < 20 dB) were achieved by 63.2 per cent of group 1 patients and 78 per cent of group 2 patients. CONCLUSION: Incus interposition and bone cement ossiculoplasty are safe and reliable methods with which to manage incus long process defects. Bone cement ossiculoplasty gives a greater hearing gain in appropriate cases.

Management of mycobacterial cervical lymphadenitis.

The treatment results of mycobacterial cervical lymphadenitis in 69 patients between 1990 and 1993 are reviewed. All patients underwent surgical procedures consisting of total excision or selective nodal dissection for lymphadenopathies and curettage for fluctuant cases, followed by antituberculous chemotherapy applied according to the likely or proved mycobacterial species. For this purpose, three or four drugs (including isoniazid, rifampin, ethambutol, and streptomycin) were used for 12 to 18 months. The cure rate was 100% after a minimum follow-up of 3 years. Clinical features, treatment modes, and guidelines for management are discussed.

Congenital cholesteatoma with spontaneous epidural abscess, sinus thrombosis and cutaneous fistula.

A congenital cholesteatoma or epidermoid is a benign mass that causes devastating effects if left untreated. An unusual case with a congenital cholesteatoma located in the mastoid region complicated by epidural abscess, sinus thrombosis, and cutaneous fistula is presented. The patient had normal otologic findings and had no neurologic deficit. A review of the literature found no report of a similar case.

Three-layer reconstruction with fascia lata and vascularized pericranium for anterior skull base defects.

BACKGROUND: We report an assessment of the efficiacy of a triple layer graft composed of fascia lata and vascularized pericranium for anterior skull base reconstruction. This technique is based on the concept that vascularized tissue over a free flap may promote vascularization and rapid wound healing. METHOD: A large fascial graft is prepared from the fascia lata and divided in two pieces and trimmed to a size larger than the bone and dural defect. Vascularized pericranium is harvested after bicoronal incision and elevating the bifrontal scalp flap down to the supraorbital rims. First is dural repair, which is performed with fascia lata placed between the brain and remaining dura. Second, fascia lata is placed over the skull base defect and secured with mini titanium screws over the cranial surface of the orbital ridges. Third, vascularized pericranium is laid between the two layers of fascia lata. FINDINGS: We studied 17 patients of whom 2 had malignancy, 6 had olfactory groove meningioma, 6 had skull base fracture and rhinorrhea, 1 case had orbital meningioma, 1 had invasive pituitary adenoma and 1 had basal encephalocele. The transbasal approach was used as a single procedure in 13 cases. The extended transbasal approach combined with a transfacial approach was used in 3 cases and with a pterional approach in 1 case. In each patient, reconstruction of the cranial base was performed with triple layer graft of fascia lata and vascularized pericranium. The patients were followed-up 2 months to 5 years. None of the patients experienced postoperative cerebrospinal fluid leakage, meningitis, abscess, brain herniation and tension pneumocephalus. INTERPRETATION: Fascia lata with vascularized pericranium is highly reliable, tensile and well suited for reconstruction of the anterior skull base.

Mycobacterial species causing cervicofacial infection in Turkey.

The aim of the study was to determine the mycobacterial species causing cervical lymphadenitis at Cukurova University Hospital, Adana, Turkey. To this end, culture and differential tests were performed on excisional or incisional biopsy specimens from patients with mycobacterial cervical disease (MCD). The diagnosis was confirmed by skin tests, histopathological examination and positive cultures. In 15 of 40 cases diagnosed as MCD, mycobacteria were isolated in Lowenstein-Jensen medium. The etiological agents were tuberculous mycobacteria (Mycobacterium tuberculosis in 9 cases and M. bovis in 3 cases). Of the 3 non-tuberculous cases, 2 were due to M. kansasii and the other to M. fortuitum. Antituberculous chemotherapy was given in all cases over an average period of 18 months. A combination of three of four drugs was used including isoniazid, ethambutol, rifampin and/or streptomycin. At the end a follow-up period of at least 3 years, there were no recurrences or persistences of infection and no surgical treatment was necessary to remove residual lymph nodes.

Significance of the auditory tube angle and mastoid size in chronic ear disease.

The aim of this study was to determine whether a relationship exists between mastoid size and auditory tube angle (ATA) and chronic ear disease. A radiological and clinical study was undertaken of the temporal bones of 36 subjects. There were 24 patients with unilateral chronic otitis media (COM) and 12 healthy controls (HC): the contralateral healthy ears of the COM patients were also used as control (CLHC). From each CT scan the distance between Henle spine and the sigmoid sinus (H-SS) and the ATA was assessed. The angle between a longitudinal line bisecting the transverse length of the external auditory canal and the longitudinal axis of the AT was calculated. A direct correlation between H-SS and ATA, both in COM and HC (p < 0.01), was observed, but not in CLHC (p > 0.05). There was no significant difference in the ATA results between COM and CLHC, or between COM and HC (p > 0.05), however there was a significant difference between CLHC and HC (p = 0.02). H-SS distances were not significantly different between COM and CLHC, or COM and HC, or CLHC and HC (p > 0.05). An association between ATA and mastoid size in both healthy and diseased ears was observed. The anatomical relationships of the AT, mastoid and middle ear, which form a functional unit, are not significantly important in chronic ear disease.