Ear protrusion after tympanoplasty and the use of mastoid dressing.

OBJECTIVES: This study aims to assess possible wound complications of tympanoplasty and tympanomastoidectomy with or without postoperative mastoid dressing. PATIENTS AND METHODS: A total of 37 patients (22 females, 15 males; mean age: 23.88 years; range 9 to 64 years) who underwent middle ear or mastoid operations via postauricular incision were included in this prospective, randomized, controlled study. The patients were divided into two groups as having mastoid dressing (n=17) and nonmastoid dressing (n=20). Through a close follow-up, postoperative complications were noted and distance from mastoid scalp and auricular rim was measured. RESULTS: The mean mastoid-helix distance of non-mastoid dressing group was found 17.2 mm in operated and 16.9 mm in non-operated ears. The mean mastoid-helix distance of mastoid dressing group was 15.53 mm in operated ears and 16.47 mm in non-operated ears. Skin erythema was seen in a patient. There was no statistically significant increase in mastoid-helix distance (p>0.05). CONCLUSION: Tympanoplasty with or without mastoidectomy does not cause postoperative complication or protrusion of the ear, even if no mastoid dressing is used. Our study results suggest no benefit of mastoid dressing after tympanoplasty with or without mastoidectomy.

The effect of retinyl palmitate on healing of benign vocal fold lesions.

The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.

Hearing and cochlear function of patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder that primarily affects the spine and sacroiliac joints. Recent studies described audiovestibular impairment in AS patients. The aim of this study was to evaluate the hearing and function of the cochlear system in patients with AS. Thirty-seven AS patients and 20 healthy controls were evaluated prospectively. Otorhinolaryngologic examinations were performed in all patients together with pure tone audiometry, speech discrimination test, tympanometry, and distortion product otoacoustic emission (DPOE). Disease duration, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, and hematologic findings (CRP and ESR) were also collected. Pure tone audiometry findings of the patients and controls were significantly different in all frequencies (p < 0.01). Speech discrimination scores were also significantly different (p < 0.01). No significant difference was found between DPOE responses of the patients and controls (p > 0.05). There was no correlation between disease duration, BASDAI scores, hematological findings, and audiometry findings (p > 0.05). This study demonstrated that there is an association between AS and hearing loss, but the cochlea is not the main source of hearing loss.

The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation.

OBJECTIVE: The aim in this study was to evaluate the efficiency of Nasal Obstruction Symptom Evaluation (NOSE) scale for septoplasty (without turbinate reduction) in comparison with other examination methods. METHODS: Prospective observational study was undertaken in otolaryngology department of university hospital. NOSE scale for quality of life assessment, visual analog scale for examination findings, acoustic rhinometry and coronal computed tomography were performed before and after septoplasty. The efficiency of NOSE scale to assess for septoplasty results and the correlation between NOSE scores and other techniques was analyzed. RESULTS: Twenty-seven patients underwent septoplasty; there was a very significant improvement in mean NOSE scores of patients (60.2 versus 11.28, p<0.01). There was no correlation between NOSE scores and acoustic rhinometry. Correlation was found between NOSE scores and examination and computed tomography findings (p<0.05). CONCLUSION: NOSE scale that is well correlated with examination findings and computed tomography, is very useful tool to evaluate the effectiveness of pure septoplasty.

Stereological volumetric evaluation of the cerebellum in benign paroxysmal positional vertigo.

OBJECTIVE: To evaluate cerebellar volume changes and the asymmetry of patients with benign paroxysmal positional vertigo (BPPV). METHODS: The cerebellar hemispheres` volumetric symmetry were evaluated using a stereological method on MR images. The study included 15 patients with BPPV, and 14 age-, and gender-matched control subjects. The cases were admitted to the Departments of Otolaryngology, Neurology, and Neurosurgery in the Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey with the complaint of vertigo between January 2004 and December 2008. RESULTS: The right hemi cerebellum volumes of the subjects with BPPV and the controls were measured smaller than the left hemi cerebellar volumes, however, there was no statistically significant quantitative evidence detected in terms of cerebellar asymmetry between sagittal and axial plane estimates in the cases with vertigo. There was statistical significance between the right and left cerebellum in both the patient and control groups (p=0.023), however, the difference did not change according to gender. There were no statistically significant age and gender dependent cerebellar atrophy and asymmetry between BPPV and control subjects. CONCLUSION: There was no cerebellar atrophy and asymmetry between BPPV and age matched control groups. The stereological evaluation of hemi cerebellar symmetry and atrophy in humans is important for both clinicians and anatomists. The technique is simple, inexpensive, and reliable.

[Hearing aid use and patient satisfaction]. / Isitme cihazi kullanimi ve hasta memnuniyeti.

OBJECTIVES: In this study, we assessed the hearing aid usage ratios and durations, patient satisfaction and the probable causes of disuse if they are not used. PATIENTS AND METHODS: A questionnaire with 16 questions was applied to the patients who were prescribed hearing aids in our clinic between January 2007 and December 2009. A total of 517 patients were called by phone. Hundred and seventy-nine of the patients (75 females, 104 males; mean age 60±23 years; range 17 to 94 years) participated in the trial. Hearing aid usage ratios and patients' satisfaction were determined and the factors influencing usage were statistically investigated. RESULTS: Hundred and forty-two of the patients used their hearing aids regularly and 37 of the patients either used their aids rarely or never used them. The most common cause reported for disuse was the frequent noise coming from the hearing aid. CONCLUSION: Failure to explain the usage of the hearing aids to the patients and age over 70 years have a statistically significant negative effect on the duration of hearing aid use and patient satisfaction.

How smell tests experience and education affect ENT specialists' attitudes towards smell disorders? A survey study.

The aim of the present study was to assess the effect of smell tests experience and education during residency or in general practice on ENT specialists' attitudes toward smell disorders in concern of their management strategies. Methodology included a voluntary and anonymous self-administered questionnaire survey conducted in Turkey and responses from 218 questionnaires were pooled and evaluated. Results stated that only 7.3% of the respondents reported currently using smell tests in their practice, and most of those had observed a smell test during their residency (p < 0.05) and received education on the olfactory disorders (p < 0.01). Furthermore, these doctors were more likely to manage patients with no assistance from other doctors or institutions (p < 0.01). Moreover, the doctors with more knowledge of smell disorders rated the symptom of smell loss as more important. We concluded that doctors who had training in smell disorders were confident in diagnosing and treating patients with smell disorders and were more likely to perform smell tests and assume all responsibility for diagnostic and treatment procedures. These results demonstrate the importance of both the residency and continuing medical education in training doctors who are confident to treat smell disorders.

Oncocytic lipoadenoma of the parotid gland: a case report with fine needle aspiration cytology findings.

Oncocytic lipoadenoma of the salivary gland is a rarely encountered tumor. A 56-year-old man presented with a two-year history of a slow-growing mass of the left parotid gland. Computed tomography scan with contrast showed a 7x6.5x6 cm well-circumscribed solid parotid mass of the left superficial and deep lobe. Fine-needle aspiration yielded oncocytic cells exclusively, suggesting Warthin tumor or an oncocytoma. Left total parotidectomy was performed. A diagnosis of oncocytic lipoadenoma was made. At six-month follow-up no evidence of recurrence has been noted. Oncocytic lipoadenoma should be considered in the differential diagnosis of oncocytic proliferations and oncocytic tumors in the parotid gland.

Metastatic basal cell carcinoma presenting as a neck mass.

Neck masses are common in physicians' daily practice; however, there is a small possibility that the origin of the neck mass is a basal cell carcinoma (BCC). We present a BCC of the scalp that metastasizes to the neck without any lymphoid involvement. We also reviewed possible risk factors for metastasis of the BCC, which is a probable cause of neck mass.

The role of MMP-9 and TIMP-1 in nasal polyp formation.

OBJECTIVE: The complex structure of polyp formation is still unknown. Matrix metalloproteinases (MMPs), a family of zinc-dependant endopeptidases with proteolytic activities towards several components of extracellular matrix, play an important role in connective tissue remodeling. Tissue inhibitors of matrix metalloproteinases (TIMPs) are natural inhibitors of MMPs. The balance between MMP/TIMP is very critical in matrix remodeling and various physiological processes. Imbalances between these enzymes and inhibitors may cause pathological processes such as chronic inflammation, degenerative disease and tumour invasion. In our study we aimed at demonstrating MMP/TIMP imbalance in nasal polyposis, similar to other pathological processes. STZUDY DESIGN AND SETTING: Nasal polyp specimens were obtained from twenty patients with nasal polyposis during endoscopic sinus surgery. Bullous middle turbinates with normal appearing mucosa of fifteen non-smoker patients free of any allergic or infectious diseases of nose or sinuses were used as controls. We measured the MMP-9 and TIMP-1 levels in tissue specimens using an ELISA method. RESULTS: MMP-9 levels were significantly increased and TIMP-1 levels were significantly decreased in polyp tissues in comparison to controls with no correlation observed between MMP-9 levels and inflammatory cell populations. CONCLUSION: MMP-9 and TIMP-1 may play an active pathogenic role in nasal polyp formation. MMP-9 levels are regulated independently from inflammatory cell populations.

Expression and distribution of aquaporin-1 in nasal polyps: does it have any significance in edema formation?

BACKGROUND: The aim of this study was to investigate the expression of Aquaporin 1 (AQP1) and AQP4 in polyp tissue. METHODS: Nasal polyps were obtained from 34 patients with nasal polyposis during endoscopic sinus surgery. Bullous middle turbinates with normal-appearing mucosa of 10 patients were used as controls. Expression of AQP1 and AQP4 water channels were determined by immunohistochemical methods. RESULTS: AQP1 has been found to be expressed in fibroblasts located in polyp tissue, especially in the subepithelial area, periphery of seromucous glands, and endothelial cells of venules. CONCLUSION: We have established a high expression of AQP1 water channels in nasal polyp tissue and have suggested two mechanisms to explain this finding. Increased AQP1 expression may be a cause or a consequence of edema formation. Thus, additional studies are needed to elucidate the true mechanism underlying this relationship.

Anesthesia management in Kabuki make-up syndrome.

Kabuki make-up syndrome KMS is a rare condition with a number of characteristic congenital abnormalities. The syndrome is characterized by peculiar facial appearance resembling the make-up of actors in Kabuki, the traditional Japanese theater, skeletal anomalies, dermatoglyphic abnormalities, postnatal growth deficiency, and mental retardation. These are rare reports of central nervous system dysfunctions, other than mental retardation, and no previously described congenital talipes calcaneo-valgus in this syndrome. We report the case of a 22-month-old girl having Kabuki make-up. At presentation, she had an adenoid hypertrophy and a history of recurrent otitis media. She had also delay in motor development, and a postnatal growth deficiency. The variable phenotypic expression is a well-known characteristic of the syndrome. For that reason, we should perform careful morphologic examination in every patient and their parents, and use flexotype laryngoscope Heine, Germany to visualize vocal cord in case of difficult intubation. At preoperative examination, as clinicians, we must be careful regarding patient morphology. Congenital heart defects and epilepsy are important for anesthesia management in KMS.

The correction of velopharyngeal insufficiency by Furlow palatoplasty in patients older than 3 years undergoing Veau-Wardill-Kilner palatoplasty: a prospective clinical study.

BACKGROUND: Velopharyngeal insufficiency may persist after primary repair of the palate. This insufficiency causes a speech deficit. Although there are many treatment alternatives, the most effective treatment of velopharyngeal insufficiency remains controversial. METHODS: The authors performed Furlow palatoplasty in patients older than 3 years who had undergone primary palatoplasty with the Veau-Wardill-Kilner technique. Speech was assessed by a speech therapist before and after the operation. Velopharyngeal closure and velum motion were recorded using a video nasendoscope before and also 12 months after the operation. Any increase in velum length was measured. RESULTS: After Furlow palatoplasty, 10 of 27 patients (37 percent) made complete recovery and 12 (44 percent) made substantial recovery from hypernasal resonance, but five (18.5 percent) showed no improvement. Regarding nasal emission, 16 of 27 patients (59.3 percent) made complete and eight (29.6 percent) made substantial recovery, but there was no change in three (11 percent). Five of 27 patients (18.5 percent) achieved complete intelligibility and 18 of 27 (66.7 percent) improved intelligibility, but four (14.8 percent) did not show any improvement in intelligibility. Articulation improved considerably in 17 of 27 (63 percent). The overall rate of surgical success and near misses who benefited from the surgery was 18 of 27 (67 percent), and a positive correlation between surgical success and articulation and intelligibility was noticed. Video nasendoscopy showed complete velopharyngeal closure in 15 of 27 patients (56 percent). The mean velar length increased by 44 percent. After secondary Furlow palatoplasty, patients with small gaps benefited more. CONCLUSIONS: The results suggest that Furlow palatoplasty performed in later years improves not only speech but also velopharyngeal closure by reorienting the levator veli palatini muscle and augmenting the velum.

Does Helicobacter pylori have role in development of otitis media with effusion?

OBJECTIVE: Recently, it was suggested that tonsil and adenoid tissues may act as a reservoir for Helicobacter pylori (HP). A connection between chronic tubotympanal disorders and gastroesophageal reflux is well recognized, but the mechanism underlying this relationship is unclear. In this study, we investigated possible presence of HP in adenoid tissue and middle ear effusions in patients with chronic otitis media with effusion (OME) and we compared the data with the results of the children who had adenoid hypertrophy without OME. METHODS: The study was comprised of 38 consecutive children with adenoid hypertrophy and/or chronic OME. The patients were divided into two groups. The first group included 18 subjects having OME+adenoid hypertrophy and the second group included 20 subjects having solely adenoid hypertrophy. Each patient underwent the appropriate surgical procedure; myringotomy, placement of tympanostomy tubes and/or adenoidectomy. After myringotomy, the middle ear effusions were collected in a suction and collection device and a core biopsy specimen was taken from each adenoid tissue following adenoidectomy. DNA extracted from these samples was used for the amplification of 23S ribosomal RNA gene of HP by real-time polymerase chain reaction (RT-PCR). RESULTS: In the first group 34 effusion samples were obtained from ears of 18 patients (two had unilateral OME). HP was found to be positive in 12 children (67%) and 16 of 34 ears (47%) with RT-PCR. In eight children HP was positive in only one ear and in four children in both ears. No positive reaction was seen in tissue samples obtained from adenoids of these patients. In the second group a positive reaction was seen in adenoid tissue of only one patient. CONCLUSIONS: This study showed that there is HP presence in middle ears of the children with chronic OME, indicating HP having a possible role in OME pathogenesis. In addition, we demonstrated HP presence in only 1 of 38 adenoid specimens supporting the idea that adenoid tissue does not act as a reservoir for HP.

Congenital vomeral bone defect.

Congenital anomalies of the nose is comprised of a broad spectrum of different types of malformations ranging from a minor alar cleft to total agenesia. Reports about congenital septal defects are few in literature. In this manuscript, we report on a 19-year-old male patient with a congenital defect on the posteroinferior portion of the septum. The defect was diagnosed by endoscopy and confirmed by computed tomography. This defect probably occurred because of an arrest in development of vomeral bone. The literature on this rare occurrence is reviewed, and the significance of the patient is discussed.

The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children.

PURPOSE: It is well known that hypertrophic tonsils and adenoids may cause upper-airway obstruction. The aim of this study is to determine the mean pulmonary arterial pressure (mPAP) in children with hypertrophic tonsils and adenoids and to clarify whether tonsillectomy and adenoidectomy (T&A) has any effect on mean pulmonary arterial pressure of these children. MATERIALS AND METHODS: Fifty-two randomly selected children (36 male, 16 female) aged between 4 and 11 (mean 7.7+/-2.5) a with a diagnosis of upper-airway obstruction resulting from hypertrophied tonsils and adenoids were included in our study. Thirty-three children were assigned as controls with similar age and sex distribution with the study groups. Mean pulmonary arterial pressure was measured by using Doppler echocardiography preoperatively and mean 5.4+/-2.9 months postoperatively in all subjects. RESULTS: When the mean pulmonary arterial pressure values of study and control group compared preoperatively, the mean pulmonary arterial pressure levels of the children in the study group were significantly higher than the mean pulmonary arterial pressure levels of the children in the control group (P<.05) (study group mean PAP=23.13+/-7.68, control group mean PAP=16.11+/-7.24) (Levene's test, P<.05). When the preoperative and postoperative results were compared, it was found that there was a statistically significant decrease in mean pulmonary arterial pressures in these 52 children (preoperative mean PAP=23.13+/-7.68, postoperative mean PAP=17.00+/-6.99) (paired sample t test, P<.05). Twenty-seven of the 52 subjects in the study group were pulmonary hypertensive preoperatively. mPAPs of 18 of these children decreased to normal range yielding 9 subjects, and this was also found ststistically significant (McNemar test, P<.001). CONCLUSION: This study showed that obstructive adenoid and tonsillar hypertrophy causes higher mPAP values in children and revealed that T&A is an effective therapeutic measure in such patients.

[Spontaneous trans-sphenoidal encephalocele presenting with nontraumatic cerebrospinal fluid rhinorrhea (case report)]. / Nontravmatik rinoreye yol açan spontan transsfenoidal ensefalosel.

Encephaloceles are uncommon and can arise from congenital, traumatic, or spontaneous origins. Approximately 80% of all cerebrospinal fluid rhinorrheas are caused by head injuries. Spontaneous or nontraumatic encephaloceles or cerebrospinal fluid leaks have been the least common in most series, accounting for only 3% to 5% of all cerebrospinal fluid leaks. There is a high incidence of meningitis and brain abscess. Thus, early diagnosis is very important. We present an adult patient with uncomplicated nontraumatic cerebrospinal fluid rhinorrhea that was caused by spontaneous trans-sphenoidal encephalocele.

Effects of ascorbic acid on oxidative system and transient evoked otoacoustic emissions in rabbits exposed to noise.

OBJECTIVES/HYPOTHESIS: The objective was to investigate the effects of both noise exposure and ascorbic acid on oxidative status and hearing thresholds of rabbits. STUDY DESIGN: Randomized prospective animal study comparing oxidative parameters and otoacoustic emissions in two rabbit groups exposed to noise. One group was given ascorbic acid, the other group was not given any treatment. METHODS: Two groups of rabbits were used in the study; each group had six rabbits. The six rabbits in the first group were not given any treatment, whereas 500 mg intramuscular ascorbic acid twice daily for 2 1/2 days was given to the six rabbits in the second group. Transient evoked otoacoustic emissions were recorded in all animals before and after noise exposure. Total protein sulfhydryl groups, carbonyl contents, and malondialdehyde levels, as well as erythrocyte glutathione, superoxide dismutase, and catalase enzyme levels, were measured in all rabbits. All the rabbits were exposed to noise (100 dB sound pressure level, 1000 Hz, 1 h), and transient evoked otoacoustic emissions were recorded again. RESULTS: When oxidative parameters before noise exposure were compared, erythrocyte glutathione and catalase enzyme levels were detected to be higher in the second group (P <.05). In the first group of rabbits after noise exposure, total protein sulfhydryl groups were found to be reduced (P <.05), whereas plasma carbonyl contents and malondialdehyde levels were elevated significantly (P <.05). In this group, erythrocyte glutathione, superoxide dismutase, and catalase enzyme levels were low (P <.05). In the second group, which was given ascorbic acid, total protein sulfhydryl groups were reduced (P <.05), whereas plasma carbonyl contents and malondialdehyde levels did not change (P >.05) following noise exposure. In the second group, erythrocyte glutathione and catalase enzyme levels were reduced (P <.05), but superoxide dismutase levels did not change (P >.05). Transient evoked otoacoustic emissions after noise exposure were weak in both groups, but reproducibility and signal-to-noise ratios were higher in the second group (P <.05). CONCLUSION: Ascorbic acid treatment inhibited both lipid peroxidation and oxidative damage of proteins in rabbits exposed to noise. The study data suggest, at least, that oxidative status should be included in the physiopathology of noise-induced hearing loss; in addition, a brief application of ascorbic acid before noise exposure appeared to play a protective role for cochlea.

Coexistence of choanal atresia and Tessier's facial cleft number 2.

Choanal atresia is one of the most commonly observed congenital abnormalities of the nose. This defect is frequently associated with other congenital anomalies. One of the anomalies, which is rarely encountered is a Tessier's facial cleft 2. In this report, we present a 6-year-old girl who was brought to our department with complaints of nasal obstruction and chronic nasal discharge. On examination, a scar was seen on the left ala of her nose due to the former repair of a congenital defect. We found hypoplastic nasal cavities and bilateral choanal atresia demonstrated by rigid and flexible endoscopy. A CT scan supported these findings. This coexistence of bilateral choanal atresia with a number 2 facial cleft is an addition to a formerly proposed classification of laterofacial clefts. We think that this classification is better for describing the extent and origin of these complex lesions.

Schwannoma of the upper lip: a case report.

Schwannomas are neurogenic tumors that arise from the Schwann cells of the nerve sheath. They are benign, usually solitary, and encapsulated neoplasms. In this report, a 29-year-old woman with a complaint of painless swelling in the upper lip is presented. Computed tomography showed a well-circumscribed solid mass. The lesion was excised and histopathologic diagnosis was made as schwannoma. The postoperative course was uneventful. No recurrence was observed during a follow-up period of 12 months.