Nasolacrimal duct intubation in the treatment of congenital nasolacrimal duct obstruction in older children.

PurposeThe purpose of this study was to investigate the outcomes of nasolacrimal duct intubation in the primary treatment of congenital nasolacrimal duct obstruction (CNLDO) in children aged 7 years and older.MethodsThirty children aged ≥7 years who underwent primary unilateral nasolacrimal duct intubation because of CNLDO were enrolled in this study. CNLDO diagnosis was based on signs and symptoms including typical epiphora, increased tear meniscus, recurrent or persistent mucopurulent discharge, and an abnormal dye disappearance test (DDT). Surgical success was defined as complete resolution of previous signs and symptoms and DDT grade 0-1.ResultsThe mean age was 10.7±2.5 years (ranging from 7 to 15 years). Of the 30 patients, 18 were male and 12 were female. The mean follow-up period was 8.8±3.4 months (ranging from 6 to 16 months). The mean silicone tube removal time was 4.6±1.1 months (ranging from 3 to 6 months). The complete resolution of signs and symptoms with DDT grade 0-1 was observed in 22 of 30 cases (73.3%) during the follow-up period. The mean age of the patients with unsuccessful outcomes was 12.7±1.4 years, whereas that of the patients with successful outcomes was 10.0±2.4 years, and the difference was statistically significant (P=0.006). No serious intra- and/or post-operative complication was observed.ConclusionsThe current study demonstrates that nasolacrimal duct silicone intubation with intranasal endoscopic visualization has favorable outcomes as a primary treatment of persistent CNLDO in children aged 7 years and older. It can be used to reduce the need for dacryocystorhinostomy which is a more invasive procedure.

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.

Promontory hemangioma mimics glomus tympanicum in the middle ear (promontory hemangioma).

Hemangiomas, common benign vascular tumors, have been well reported in the head and neck region. They have rarely been reported in the ear. Ear involvement hemangiomas are usually seen in the together with external auditory channel and middle ear. We presented a 62-year-old woman of capillary promontory hemangioma which was mimicking as glomus tympanicum with a review of the literature.

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.

Comparison of pre-emptive tonsillar lodge infiltration with ropivacaine versus intravenous tramadol in pediatric tonsillectomies: a randomized placebo-controlled study.

OBJECTIVE: To investigate the placebo controlled effect of pre-emptive local infiltration of ropivacaine and intravenous tramadol in postoperative pain and nausea-vomiting in pediatric tonsillectomy cases. METHODS: 90 children at ASA I-II physical status, who are between 2 and 9 years old, underwent tonsillectomy were included to the study. Patients were randomized into one of three study groups. Group I was i.v. saline group (placebo group), Group II was preemptive 1.5 ml 0.75% ropivakain to the tonsil lodge and Group III was preemptive 1mg/kg i.v. tramadol. Hemodynamic parameters and synchronized Maunuksela pain scores were evaluated in the post anesthetic care unit. RESULTS: There was no difference in age, weight, sex and hemodynamic parameters of children included to the study groups. Postoperative nausea vomiting was significantly lower in Group II and pain scores at resting and swallowing are significantly lower than the other study groups. Maunuksela pain scores at 2nd, 3rd, 6th and 9th hours while resting were significantly lower in Group II compared with Groups I and III (p<0.001). The comparison of scores between groups I and III were similar. Maunuksela pain scores during swallowing were significantly lower in Group II compared with Group I and III at 2nd, 3rd, 6th, 9th, 12th, 21st and 24th hours postoperatively (p<0.001). While comparing Maunuksela pain scores of Groups I and III, significantly lower scores are determined at 2nd and 24th hours in Group III (p<0.001). Analgesic needs were significantly low in Group II at postoperative period (150 ± 30 mg paracetamol) (p<0.05). It was similar in Groups I and III (Group I: 400 ± 40 mg, Group III: 360 ± 40 mg paracetamol). CONCLUSION: This study showed that peritonsillar ropivacaine infiltration might produce an effective postoperative analgesia probably due to a preventing effect on sensitization of the pain pathways.

Immunohistochemical analysis of PCNA, Ki67 and p53 in nasal polyposis and sinonasal inverted papillomas.

Immunoreactivity of proliferating cell nuclear antigen (PCNA), Ki67 and p53 in inflammatory nasal polyp and inverted papilloma tissues was investigated. Immunohistochemistry was performed using a standard avidin-biotin-peroxidase method, and the immunoreactivity of PCNA, Ki67 and p53 was quantified by counting immunostained nuclei in at least 1000 epithelial cells. The mean labelling index (percentage of immunostained cells) for PCNA was 40.68 in the inverted papilloma group and 14.73 in the nasal polyp group, and for Ki67 was 15.43 in the inverted papilloma group and 2.64 in the nasal polyp group. Both of these differences between the inverted papilloma and nasal polyp groups were significant. Immunoreactivity for p53 was detected in five (35.7%) inverted papilloma patients and two (9.5%) nasal polyp patients. The increase in epithelial cell proliferation seemed to be greater in inverted papillomas than in inflammatory nasal polyps. Increased epithelial cell proliferation may be involved in the development of inverted papillomas.