[Endoscopic treatment of idiopathic spontaneous although cerebrospinal fluid rhinorrhea: a case report]. / Idyopatik spontan beyin omurilik sivisi rinorenin endoskopik tedavisi: Olgu sunumu.

Although cerebrospinal fluid (CSF) rhinorrhea is a rarely seen clinical entity, it is a condition which should be considered carefully by otolaryngologists and neurosurgeons because it has the possibility of serious complications unless it is treated. Trauma is the most common causative factor. Idiopathic spontaneous CSF rhinorrhea is a very rare entity which is difficult to manage and which has high recurrence rates. Although in the past CSF rhinorrhea used to be treated by intracranial route, nowadays endonasal endoscopic surgery is preferred because of wide usage of rigid endoscopes with much fewer complications, In this article, a case of 43-year-old female with idiopathic spontaneous CSF rhinorrhea repaired by endonasal endoscopic surgery is presented, and the diagnosis and the treatment of CSF rhinorrhea is reviewed.

Comparison of nasal region dimensions in bilateral choanal atresia patients and normal controls: a computed tomographic analysis with clinical implications.

OBJECTIVE: To determine if any difference exists between a set of nasal dimension measurements in choanal atresia patients and in a control group. METHODS: A retrospective study was undertaken to define the variation of values for a series of nasal dimension measurements through axial computed tomography in 9 patients with bilateral choanal atresia and compare the same dimensions with a control group 104 patients of similar gender and age distribution. The statistical significance of the differences in these dimensions was examined. RESULTS: Nine of 17 variables showed a significant difference between normal and choanal atresia group. The result showed that the growth of the nasal complex can be influenced by nasal obstruction. CONCLUSION: These findings might serve in understanding the differential growth patterns of nasal structures in the face of the nasal breathing obstruction. Computed tomography is valuable in defining the exact anatomical extent of the disease and also in preoperative evaluation of the patient.

Effects of various densities of middle ear fluids on acoustic immittance: experimental study.

OBJECTIVE: To study the effects of various densities of middle ear fluids on acoustic immittance and elucidate the characteristics of this study that might be beneficial for clinical use in otitis media with effusion. STUDY DESIGN: Experimental, in vivo model. MATERIALS AND METHODS: The study was performed on 12 ears of six white Vienna rabbits. Rabbits were placed in six positions: normal resting position (group 1); after drilling a hole into the tympanic bulla (group 2); filling the bulla with distilled water (group 3; density = 1000 g/cm(3)); filling the bulla with 8.4% bicarbonate solution (group 4; density = 1005 g/cm(3)); filling the bulla with Tonimer gel (group 5; density = 1035 g/cm(3)); and filling the bulla with glycerine (group 6; density > 1050 g/cm(3)). Acoustic immittance measurements were then made in vivo. During each measurement, volume, compliance, pressure, and gradient values were recorded. Analysis of variance, Student t-test, and Pearson correlation coefficient and multiple regression analyses were used for statistical evaluations of the data. RESULTS: Volume, compliance, and pressure values were obtained in all of the six measurements. A significant difference in volume was found between groups 1 and 2 (p < .001) and between the other four groups in this study (p < .001). With regard to compliance, group 2 was significantly different from groups 3, 4, 5, and 6 (p < .001). With regard to pressure, there was no intergroup (1 and 2) difference (p = .639); however, a significant difference (p < .001) was found between groups 1 and 2 and the other four groups. A significant difference was found between groups 3 and 6 (p = .006). A gradient value was obtained in all of the six measurements only for groups 1 and 2. In group 2, a significant rise in gradient was observed (p = .001). CONCLUSION: Generally, volume, compliance, and pressure values declined significantly in rabbits in which the bulla had been filled with fluid when compared with rabbits with empty bullae. Drilling a hole into the bulla increased volumetric values under normal conditions but had no effect on compliance and pressure values. The significant difference between groups 3 and 6 regarding pressure demonstrates that the density of fluid in the middle ear plays a role in pressure values when measured with tympanometry. We conclude that the correlation between density and pressure values of middle ear fluids may be useful in the clinical decision-making process when treating disorders such as otitis media.

[A case of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms]. / Kokleovestibüler semptomlarin ön planda oldugu herpetik fasyal paralizi: Olgu sunumu.

A 42-year-old man presented with sensorineural hearing loss of acute onset, tinnitus, and vertigo. Physical examination revealed slight asymmetry in facial nerve functions and spontaneous nystagmus. Magnetic resonance imaging of the internal acoustic canal showed contrast enhancement consistent with edema-inflammation, being notable and diffuse in the seventh and eighth cranial nerve complex, and minimal in the cochlea. Non-hydropic cochleovestibular syndrome was considered and the patient was treated with antiviral and corticosteroid medications. A week later, facial paralysis improved and the acute hearing loss reversed. On the twelfth day of presentation, he had no complaints other than mild imbalance on abrupt changes in movement. In this type of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms, it might be argued that varicella zoster virus reactivation occurs in the spiral and/or vestibular ganglion.

Case report and surgical solution for nasal spine agenesis in a woman with Binder syndrome.

Binder syndrome is an uncommon disorder of unknown etiology. It is characterized by hypoplasia of the nose and maxilla and altered morphology of the associated soft tissue. We report a 19-year-old Binder syndrome patient with short-nose deformity and anterior nasal spine agenesis. We present a surgical technique for nasal spine agenesis treatment. We used a titanium screw without a graft, which supported the nasal tip and increased tip projection. As there is good soft-tissue coverage over the screw, infection or extrusion was not encountered, and the patient had no complaints 1 year after surgery.

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.

Congenital partial arhinia: a case report.

Congenital arhinia is an extremely rare anomaly consisting of an absence of external nasal structures and nasal passages. Fewer than 30 cases have been reported. Patients with a familial absence of the nose have been reported, but the effects of genetic and maternal factors are unknown. Midface hypoplasia may accompany arhinia. Accompanying malformations are thought to be caused by an absent or rudimentary nose. A patient with partial congenital arhinia is presented and the embryology and literature review are discussed.

Risk of contamination of nasal sprays in otolaryngologic practice.

BACKGROUND: Reusable nasal-spray devices are frequently used in otolaryngologic examinations, and there is an increasing concern about the risk of cross-contamination from these devices. The aim of our study was to determine, by means of microbiologic analysis, the safety of a positive-displacement or pump-type atomizer after multiple uses. METHODS: A reusable nasal spray bottle, pump, and tips were used in the nasal physical examination of 282 patients admitted to a tertiary otolaryngology clinic. The effectiveness of 2 different methods of prophylaxis against microbiologic contamination (the use of protective punched caps or rinsing the bottle tip with alcohol) was compared with that of a control procedure. RESULTS: Although there was no statistically significant difference in positive culture rates among the types of nasal spray bottles tested, methicillin-resistant coagulase-negative staphylococci were isolated in 4 of 198 cultures. CONCLUSION: Given these findings, we concluded that additional precautions (such as the use of an autoclave between sprays, disposable tips, or disposable devices) are warranted to avoid interpatient cross-contamination from a reusable nasal spray device.

Buffered papaverine facilitates passage of intratympanic dexamethasone to the inner ear.

CONCLUSION: We conclude that when papaverine is intratympanically administered together with dexamethasone after buffering, passage of dexamethasone to the inner ear is increased. OBJECTIVE: To determine the influences of papaverine and buffered papaverine on passage of dexamethasone administered intratympanically to the inner ear. MATERIALS AND METHODS: Twenty-seven Vienna white rabbits were divided into five groups: eight received intratympanic dexamethasone (4 mg/ml) (group 1), seven received intratympanic papaverine (10 mg/ml) + dexamethasone (2 mg/ml) (group 2), six received buffered (with sodium bicarbonate 8.4%) intratympanic papaverine (7.5 mg/ml) + dexamethasone (1.5 mg/ml) (group 3), three had basal cortisol levels in venous blood and perilymph measured (group 4), and three received intravenous papaverine + dexamethasone (group 5). At 1 h after the administration of the drugs, dexamethasone levels in ipsilateral and contralateral perilymph and venous blood were measured by radioimmunoassay. RESULTS: Animals in group 3 demonstrated the highest levels of ipsilateral perilymph dexamethasone. Ipsilateral perilymph levels were significantly higher in groups 1 and 3 than they were in the other groups (p<0.05). Although the perilymph levels observed in animals in group 2 were slightly higher than those in group 4, no significant difference existed (p = 0.160).

[Intratympanic treatment in Meniere's disease: the effect of gentamicin and dexamethasone on vertigo control and hearing]. / Meniere hastalginda intratimpanik tedavi: Gentamisin ve deksametazonun vertigo kontrolü ve isitme üzerine etkisi.

OBJECTIVES: We investigated the effect of intratympanic gentamicin and dexamethasone treatments on the control of vertigo and hearing loss in patients with Meniere's disease. PATIENTS AND METHODS: Forty-five patients with a diagnosis of Meniere's disease according to the 1995 criteria of American Academy of Otorhinolaryngology Head and Neck Surgery were assigned to receive intratympanic gentamicin (40 mg/ml, 0.7 ml; n=24; 11 males, 13 females; mean age 46 years) or dexamethasone (4 mg/ml, 0.7 ml; n=21; 8 males, 13 females; mean age 50.4 years). The results were evaluated with respect to changes in vertigo and hearing symptoms. RESULTS: In the gentamicin group, vertigo symptoms were controlled in 22 patients (92%), deterioration in hearing was seen in only two patients (8%). In the dexamethasone group, nine patients had complete follow-up. Of these, vertigo control was achieved in six patients (67%), none had worsened hearing, and one patient (5%) had improved hearing. When improvement in hearing was defined as at least a 5 dB change, then five patients (24%) benefited from treatment. CONCLUSION: Intratympanic treatment modalities in Meniere's disease are easy to perform, cheap, and effective. They are expected to have a more extensive use with higher success rates in the future.

Nasal myiasis by fruit fly larvae: a case report.

We report a case of human nasal myiasis caused by fruit fly larvae in a 33-year-old man who visited the south coast of Turkey. The fruit fly (Drosophila melanogaster) is endemic in the southern part of Turkey. Infestation with fruit fly larvae must be considered in patients who are visiting areas of the world where Drosophila is endemic. This is the first reported case of fruit fly larvae causing human nasal myiasis. The clinical presentation and treatment strategies are discussed.

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.

Frontal mucocele with an accompanying orbital abscess mimicking a fronto-orbital mucocele: case report.

BACKGROUND: Mucoceles are slowly expanding cystic lesions with respiratory epithelium containing mucus most commonly affecting the frontal and ethmoidal sinuses. They are caused by obstruction of sinus ostium. Mucoceles exert pressure on the bony boundaries and due to the proximity to the brain and orbit extension to these areas are common. CASE PRESENTATION: A case of a frontal mucocele with an accompanying orbital abscess mimicking a fronto-orbital mucocele is reported. A 77 year old female patient suffering from left sided proptosis and pain around the left eye was admitted to our department. She had a history of left frontal sinus mucocele one year ago that was offered an osteoplastic frontal sinus surgery that the patient refused. Patient had limitation of eye movements. Fundoscopic examination revealed a minimal papilledema. Coronal computerized tomography and orbital magnetic resonance imaging showed a frontal mucocele with suspicious erosion of the orbital roof and a superiorly localized extraconal mass displacing the orbit lateroinferiorly. Frontal and orbital masses had similar intensities. Thus surgery was planned for a fronto-orbital mucocele. During surgery no defect was found on the orbital roof. Frontal mucocele and orbital cystic mass was removed separately. Pathological examination showed a frontal mucocele and an orbital abscess wall. Postoperatively eye movements returned to normal and papilledema resolved. CONCLUSION: Fronto-orbital mucoceles are commonly encountered pathologies, but frontal mucocele with an orbital abscess is a rarely seen and should be kept in mind because their treatments differ.

Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere's disease.

The objective was to investigate vestibular evoked myogenic potentials (VEMP) in benign paroxysmal positional vertigo (BPPV) and Meniere's disease, and to determine if this type of testing is valuable for assessing the vestibular system. A prospective controlled clinical study was designed in a tertiary referral center setting. The 62 participants included 17 healthy controls and 45 other subjects selected from patients who presented with the complaint of vertigo (25 diagnosed with BPPV and 20 diagnosed with Meniere's disease). The main outcome measures of VEMP were recorded in all subjects and findings in each patient group were compared with control findings. The VEMP for the 30 affected ears in the 25 BPPV patients revealed prolonged latencies in eight ears and decreased amplitude in one ear (nine abnormal ears; 30% of total). The recordings for the 20 affected ears in the Meniere's disease patients revealed four ears with no response, six ears with prolonged latencies (ten abnormal ears; 50% of total). Only two (5.9%) of the 34 control ears had abnormal VEMP. The rate of VEMP abnormalities in the control ears was significantly lower than the corresponding rates in the affected BPPV ears and the affected Meniere's ears that were studied (P=0.012 and P<0.001, respectively). The results suggest that testing of VEMP is a promising method for diagnosing and following patients with BPPV paroxysmal positional vertigo and Meniere's disease. Further investigations with this method in other neurotologic pathologies might also be informative.

Mucinous cystadenocarcinoma of a minor salivary gland in the upper lip: case report.

Mucinous cystadenocarcinoma of the salivary gland is a rare entity that has only recently been described. This lesion was included in the 1991 World Health Organization Classification as "papillary cystadenocarcinoma," and that same year the United States Armed Forces Institute of Pathology classified it as "cystadenocarcinoma with or without a papillary component." Only a small proportion of salivary gland tumors are adenocarcinomas. Most mucinous cystadenocarcinomas affect the major salivary glands, particularly the parotid. These are low-grade malignancies, and most that occur in the minor salivary glands show very little aggressive behavior. These tumors are histologically similar to adenocarcinomas of the gastrointestinal tract. It is often difficult to differentiate them from other neoplasms. The differential diagnosis includes mucoepidermoid carcinoma, acinic cell carcinoma, salivary duct carcinoma, nasal adenocarcinoma, and metastatic carcinoma. This report describes the case of an 80-year-old man who presented with a painless swelling in his right upper lip that had been present for 1 month. Fine-needle aspiration biopsy of the lesion revealed inflammatory cells without an epithelial component. The treatment was wide excision, and there was no recurrence during 6 months of follow-up. The pathological diagnosis was low-grade mucinous cystadenocarcinoma of a minor salivary gland.

Tortuous internal carotid artery indenting the piriform sinus: a case report.

A case of tortuous internal carotid artery bulging and partially obliterating the piriform sinus, causing a sensation of fullness and abnormal throat, accompanied by choking spells in a 57-year-old patient is presented. Endoscopic examination and computerized tomographic angiography were useful in establishing the diagnosis. This rare anomaly should be recognized in order to prevent possible fatal hemorrhages during further surgical interventions of the piriform sinus.

Efficacy of misoprostol in the treatment of tinnitus in patients with diabetes and/or hypertension.

OBJECTIVE: To determine the efficacy of the prostaglandin E1 analogue misoprostol in the treatment of tinnitus in diabetic and/or hypertensive patients. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTINGS: Tertiary care referral center. METHODS: The subjects were 42 patients with hypertension and/or diabetes mellitus who had chronic tinnitus and had experienced tinnitus symptoms for a minimum of 6 months. Twenty-eight patients were randomly assigned to Group I (misoprostol treatment), and 14 patients to the Group II (placebo treatment). Misoprostol therapy was started at 200 microg per day, and was increased 200 microg every 7 days until a dose of 800 microg per day was reached. The same numbers of placebo tablets were given to the control group using the same schedule. Both groups were treated for 1 month. The changes in objective and subjective tinnitus findings from baseline to 1 month were assessed, and the group results were compared. The chi(2)-test, student's t-test and paired-samples t-test were used to analyze the study. RESULTS: At the completion of treatment, objective assessment showed that tinnitus loudness decreased in 13 (46%) of the 28 patients in the experimental group, whereas this was observed in only two (14%) of the 14 subjects in the placebo group. Subjective tinnitus scoring revealed improvement rates of 29 and 14% for the misoprostol and placebo groups, respectively. When t-test relating to difference between rates were performed, the difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.05), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.22). CONCLUSION: Misoprostol is an effective and safe treatment for chronic tinnitus in hypertensive and/or diabetic patients. Our results are encouraging, but further studies of larger series are needed.

Misoprostol in the treatment of tinnitus: a double-blind study.

OBJECTIVE: To test the efficacy of misoprostol as a treatment for tinnitus. DESIGN: A prospective, placebo-controlled, double-blind study. SETTING: Baskent University Otolaryngology Clinic. PATIENTS: Forty adult patients who had had tinnitus for a minimum of 6 months and were free of systemic or otolaryngologic disease. Twenty-eight patients were randomly assigned to the experimental group (group I) and 12 to the control group (group II). INTERVENTION: The respective groups received active drug and placebo in increasing doses for 4 months. The effect of medications on tinnitus were evaluated by determining improvement rates in tinnitus loudness and subjective tinnitus scoring. RESULTS: In the experimental group, 18 of 28 patients showed improvement in tinnitus loudness, representing an improvement rate of 64%. The improvement rate based on subjective tinnitus scoring was 36% (10 of 28 patients). In the control group, the improvement rate for tinnitus loudness was 33% (n = 4), and the rate for subjective tinnitus scoring was 17% (n = 2). The difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.039), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.119). When results in the experimental group were analyzed according to etiological factors, the improvement rate was highest in the sudden-onset subgroup (77%). CONCLUSIONS: Misoprostol provided therapeutic relief for some patients with tinnitus we studied, but further investigation of larger groups is needed.