Postoperative Anatomical and Functional Success Rates of Pediatric Patients with Chronic Otitis Media: Our Experiences.

The preoperative and postoperative pure-tone hearing thresholds and anatomical graft success of pediatric patients who underwent chronic otitis mediasurgery with various indications were evaluated and the factors affecting success were examined.Pediatric patients aged 6 to 18 years, who underwent ear surgery for various reasons between January 1, 2013 and January 1, 2020 were included in the study. All patients included in the sample were assessed in terms of age (< 13 and ≥ 13 years), disease type (cholesteatoma, tympanosclerosis, adhesive otitis media, chronic suppurative otitis media, isolated or traumatic tympanic membrane perforation), surgery performed (type 1 tympanoplasty, canal wall-up mastoidectomy, and exploratory tympanotomy), condition of the contralateral ear (unilateral/bilateral disease), graft material (temporal muscle fascia/tragal cartilage), preoperative and postoperative pure-tone audiometry thresholds and hearing gains, and postoperative sixth-month functional and anatomical graft success. Anatomical graft success and functional success were also evaluated according to the type of surgery performed, type of disease, type of fascia used in surgery, condition of the contralateral ear, and age. No statistically significant difference was found between the groups in terms of anatomical graft success and functional success according to the type of surgery performed (p = 0.414 and p = 0.123, respectively) and type of disease (p = 0.454 and p = 0.097, respectively). There was also no statistically significant difference between the anatomical and functional success of temporal muscle fascia and conchal cartilage grafts (p = 0.833 and p = 0.565, respectively). While no statistically significant difference was observed in graft success between the patients with and without contralateral ear disease, there was a statistically significant difference in functional success (p = 0.188 and p = 0.014, respectively). Although not statistically significant, it was observed that the anatomical graft success rates were decreased in patients with contralateral ear disease compared to those without bilateral disease (p = 0.188). There was no significant difference between age and anatomical graft success (p = 0.865) or functional success (p = 0.956). The type of disease in the diagnosed ear, presence of disease in the contralateral ear, and graft material used affect functional and anatomical graft success rates. Therefore, we believe that pediatric patients should be evaluated considering these factors in the preoperative period and the parents of these patients should be well informed about possible postoperative conditions.

Metastatic chordoma of the tongue: Case report.

Chordomas are rare bone tumors that arise from notochord remnants. They most commonly occur in the sacrum, but they also can be seen in the skull base, cervical spine, and thoracolumbar vertebrae. Chordomas account for 1 to 4% of all primary skeletal tumors. They are usually indolent, locally growing tumors. Distant metastasis has been reported in 3 to 48% of cases. When metastasis occurs, it is usually observed in the lung, bone, and liver. To the best of our knowledge, no case of a chordoma metastasis to the tongue has been previously reported in the literature. We report such a case in a 61-year-old man.

Management of Post-Intubation Tracheal Membrane Ruptures.

BACKGROUND: Iatrogenic tracheal rupture is a rare complication after intubation. Overinflation of the tracheal cuff was speculated to be a frequent cause of tracheal rupture. The surgical approach is a widespread treatment for tracheal ruptures. The aim of this study is to evaluate the results of conservative and surgical therapy approaches in tracheal rupture cases inflicted by tracheal intubation. METHODS: Data on 12 patients who experienced tracheal ruptures secondary to intubation were reviewed. The average age of the patients was 58 years (range of 38 to 81 years). Six patients were men and 6 patients were women. Four of the patients were performed thoracotomy for primary surgery and underwent surgical therapy. 8 patients were treated conservatively. The results of both approaches were evaluated. RESULTS: Patients, who underwent both conservative and surgical therapy, were completely recovered. There was no rupture originated complication or death. CONCLUSIONS: Both conservative and surgical therapies are appropriate for treatment of membranous tracheal rupture.

Rare Posterior Pharyngeal Mass: Atypical Marginal Zone Hyperplasia.

Cases of posterior pharyngeal masses are quite rare, and are typically derived from schwannoma or encephalocele, or are of vascular or infectious origin. They are clinically significant due to their tendency to cause airway obstruction. The aim of this study was to present a rare atypical marginal hyperplasia case of a posterior pharyngeal wall mass. A 10-year-old male was admitted to our clinic with dyspnea. A plane-surfaced 4 × 3 × 3 cm mass was observed on the posterior pharyngeal wall upon physical examination. The patient underwent magnetic resonance imaging and surgical treatment. Following excision of material from the patient's mass, a pathologic diagnosis of atypical marginal zone hyperplasia was made. Atypical marginal zone hyperplasia of the posterior pharyngeal wall has not yet been reported in the literature. Marginal zone hyperplasia associated with a lymphoproliferative disease should be considered when making differential diagnoses of posterior pharyngeal wall masses.

Recovery time for inflamed middle ear mucosa in chronic otitis media.

CONCLUSION: The present study shows that 2-3 weeks after medical treatment the status of middle ear mucosa in draining ears is similar to that of dry ears for at least 3 months. OBJECTIVE: To measure the time required for an inflamed middle ear mucosa to return into optimal state after appropriate medical treatment in chronic suppurative otitis media (CSOM). To assess optimal timing for elective surgical treatment of draining ears in uncomplicated CSOM. METHODS: In this prospective study, the Eustachian tube (ET) mucociliary clearance time (MCT) was used as the method to demonstrate the status of middle ear mucosa. In group 1 (28 patients) ET-MCT was measured in ears that were free of drainage for at least 3 months. In Group 2 (21 patients), ET-MCT was measured in draining ears, who responded to 10-14 days medical treatment, at presentation, after 10 days and 1 month. RESULTS: The ET-MCT was 8.63 ± 1.32 min in group 1 and 28.96 ± 8.19 min in group 2 at presentation; and the difference was statistically significant (p < 0.001). The ET-MCT was 14.76 ± 5.11 min after 10 days and 9.31 ± 2.33 min after 1 month in group 2. The ET-MCT was indifferent between groups 1 and 2 after 1 month (p = 0.235).

Does the Degree of Septal Deviation Affect Cribriform Plate Dimensions and Middle Turbinate Length?

OBJECTIVE: To investigate the effect of septal deviation severity on the dimensions of the lateral lamina of the cribriform plate (LLCP), middle turbinate length (MTL), and the angle of the lateral lamella of the cribriform plate (ALLCP). METHODS: Paranasal computed tomography (CT) scans of 148 patients with septum deviation (102 males, 46 females; age range 18-63 years) were retrospectively evaluated. The patients were divided into 3 groups according to the measured angle of nasal septal deviation as mild (<9°), moderate (9-15°), or severe (>15°). Height and width of LLCP, MTL, and ALLCP on both sides were measured and these parameters were compared between the groups according to the septal deviation side. RESULTS: The nasal septum was deviated to the right in 73 patients (49.3%) and to the left in 75 patients (50.7%). The LLCP dimensions, MTL, and ALLCP between the groups at the contralateral side were not statistically different (P > 0.05). The LLCP height, ALLCP between the groups at the ipsilateral side were not statistically different (P > 0.05). There was a significant difference in the LLCP width at the ipsilateral side between the groups (P = 0.039). The MTL at the ipsilateral side was significantly different between the groups (P = 0.003). CONCLUSION: The severity of nasal septum deviation in patients with nasal septum deviation affects the ipsilateral LLCP width and the ipsilateral MTL. These findings suggest that the increase in the severity of septum deviation in patients undergoing endoscopic sinus surgery does not increase the risk of possible damages that may occur in LLCP.

[Impact of markedly nasal septal deviation on 24-hour rhythm Holter findings]. / Belirgin nazal septal deviasyonlarin 24 saat ritim Holter bulgularina etkisi.

OBJECTIVES: This study aims to investigate any impact of nasal septal deviations on cardiac arrhythmias and heart rates by performing 24-hour rhythm Holter analysis before and after septoplasty accompanied by Nasal Obstruction Symptom Evaluation (NOSE) scale. PATIENTS AND METHODS: The study included 21 male patients (mean age 33 years; range 18 to 55 years) who underwent septoplasty between September 2013 and August 2014. Patients were performed 24-hour rhythm Holter electrocardiography analysis preoperatively and at postoperative third month. Supraventricular and ventricular extrasystoles were recorded pre- and postoperatively. Operation efficiency was measured with NOSE scale. RESULTS: Of the 21 patients, ventricular and supraventricular extrasystoles were observed in seven patients (33%) in the preoperative period. Mean age of patients with arrhythmia (mean age 51 years; range 18 to 55 years) was statistically significant higher compared to patients without arrhythmia (mean age 30 years; range 23 to 55 years) (p=0.012). Extrasystoles decreased in seven patients in the postoperative period. Average, minimum, and maximum heart rates did not change statistically significant in the postoperative period. CONCLUSION: The fact that septoplasty decreased arrhythmias indicates that nasal septum deviations may be associated with cardiac arrhythmias. Septoplasty had no effect on heart rates. Performing septoplasty in the early period may prevent future cardiac complications in indicated patients.

Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review.

Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

Do the angle and length of the eustachian tube influence the development of chronic otitis media?

OBJECTIVES/HYPOTHESIS: To compare the eustachian tube (ET) angle (ETa) and length (ETl) of ears with and without chronic otitis media (COM), and to determine the relationship between ET anatomy and the development of COM. STUDY DESIGN: A retrospective case-control study. METHODS: The study group comprised 125 patients (age range, 8-79 years; 64 males and 61 females) with 124 normal ears and 126 diseased ears, including ears with chronic suppurative otitis media (CSOM) with central perforation, intratympanic tympanosclerosis (ITTS), cholesteatoma, and a tympanic membrane with retraction pockets (TMRP). ET angle and length were measured using computed tomography employing the multiplanar reconstruction technique. RESULTS: The ETa was significantly more horizontal in diseased versus normal ears of all study groups (P = .030), and there was no group difference in ETl (P = .160). ETl was shorter in CSOM versus ITTS ears and normal ears (P = .007 and P = .003, respectively) and in cholesteatoma versus TMRP ears (P = .014). In the unilateral COM group, there were no significant differences in the ETa or ETl of diseased versus contralateral normal ears (P = .155 and P = .710, respectively). The ETa was significantly more horizontal in childhood-onset diseased versus normal ears (P = .027), and there was no group difference in ETl (P = .732). The ETa (P = .002) and ETl (P < .001) were significantly greater in males than females. CONCLUSIONS: A more horizontal ETa and shorter ETl could be contributory (though not significantly) etiological factors in the development of COM. LEVEL OF EVIDENCE: 3b.

Risk factors for otitis media effusion in children who have adenoid hypertrophia.

OBJECTIVE: Many studies have shown that children with adenoid hypertrophy (AH) are more likely to have chronic otitis media with effusion (COME). However, not every child with AH has COME. In this study, we investigated the socio-demographic risk factors of children who underwent surgery for AH, including a subgroup with COME. Our aim was to identify the factors involved in the development of COME. METHODS: The study population consisted of 170 pediatric patients (118 males, 52 females) who underwent adenoidectomy between 2005 and 2008. The patients were divided into two groups, those with AH alone and those with AH and COME (AH+COME). Major factors such as age, gender, breast-milk feeding, bottle-feeding, tobacco smoke exposure, familial predisposition, allergies, congenital diseases, and school attendance were compared between the two groups. RESULTS: AH alone was detected in 102 of the patients, 68% of whom were male, and AH+COME in the remaining 68, of whom 72% were male. The mean age was 6.5 years in the AH group and 5.3 years in the AH+COME group. There were no significant differences between the two groups with respect to breast-feeding, bottle-feeding, familial predisposition, tobacco exposure, and allergies. However, the relationships between COME and male sex, congenital diseases, and school attendance were significant. CONCLUSIONS: COME is seen in young children with AH. Among the socio-demographic features examined in this study, only male sex, congenital diseases, and school attendance were statistically significant risk factors for COME development.

An evaluation of biodegradable synthetic polyurethane foam in patients following septoplasty: a prospective randomized trial.

OBJECTIVE: The purpose of this study is to examine the usability of biodegradable synthetic polyurethane foam (BSPF) after septoplasty by comparing it with Merocel and silicone intranasal splints as packing materials in terms of patient comfort and efficiency. STUDY DESIGN: A prospective, unmasked, randomized trial. SETTING: A tertiary referral center. SUBJECTS AND METHODS: This study was designed to be a prospective, randomized clinical trial. Sixty-eight patients who underwent septoplasty were included in this study. The patients were randomized to receive Merocel, silicone intranasal septal splint (INS), or BSPF after septoplasty. Clinical efficacy on bleeding, pain, and subjective symptoms related to packing materials was evaluated. RESULTS: There was a statistically significant difference between the Merocel group and the other 2 groups in terms of bleeding and adhesion. The average score on the pain scale was 2.47 ± 1.01 for BSPF, 3.68 ± 1.27 for INS, and 6 ± 2.21 for Merocel. Scores on general satisfaction scales were 6.95 ± 1.42 for Merocel, 8.44 ± 2.12 for INS, and 8.28 ± 1.88 for BSPF. CONCLUSION: The efficacy of BSPF was comparable with that of Merocel and INS. Biodegradable synthetic polyurethane foam significantly reduced pain and patient discomfort during packing and removal, followed by INS, compared with Merocel.

The relationship between chronic otitis media with effusion and surface and deep flora of hypertrophic adenoids.

OBJECTIVE: The relationship between bacterial flora of the adenoids and middle ear problems is unclear. In this study, superficial and deep aerobic and anaerobic bacterial flora of adenoid tissues were compared in children with and without chronic otitis media with effusion (cOME). PATIENTS AND METHODS: Between 2004 and 2007, family members of children (ages 1-14 years) who were scheduled to undergo adenoidectomy were approached for participation in the study. Of the 180 patients who gave consent, 107 (59%) did not have cOME (Group I), whereas 73 (41%) had had a tympanostomy tube previously due to cOME (Group II). Prior to adenoidectomy, swabs were taken from the surface of the adenoids, and samples of deep tissue for culture were obtained from curetted tissue. All samples were cultured aerobically and anaerobically. Growth of 10 of the bacteria most commonly cultured were evaluated: 5 classified as normal flora (coagulase-negative staphylococci, α-hemolytic streptococci, Neisseria spp., Prevotella spp. ve Peptostreptococci) and 5 potential pathogens (S. aureus, S. pyogenes, S. pneumoniae, H. influenzae ve Moraxella spp.). RESULTS: Isolation rates of potential pathogens including S. pneumoniae,H. influenzae and Moraxella spp. from surface and deep cultures of adenoids were between 5 and 15% (no significant differences between those with and without cOME). While S. aureus was the most frequently isolated bacteria (26%) in children with cOME (Group II), the incidence of S. pyogenes as a potential pathogen was only 1% (p<0.05) in Group II and the anaerobic Prevotella spp. were significantly less common (p<0.05) in children with cOME (Group II). CONCLUSION: Potential pathogens of middle ear colonized in adenoid tissue may not be significant factor for the etiopathogenesis of cOME. Bacterial interference mechanisms may play an important role in pathogenesis of cOME because of Prevotella spp. showed statistically significant decrease children with cOME.