Impact of the 13-valent pneumococcal conjugate vaccine on the incidences of acute otitis media, recurrent otitis media and tympanostomy tube insertion in children after its implementation into the national immunization program in Turkey.

The aim of this study was to investigate changes in the incidences of acute otitis media (AOM), recurrent AOM (rAOM) and tympanostomy tube (TT) insertion in children following the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the national immunization program (NIP) of Turkey in April 2011. National coverage for the PCV7 was 97% in 2009, 93% in 2010, 96% in 2011 and for the PVC13 was 97% in 2012, 97% in 2013, 96% in 2014, 97% in 2015, 98% in 2016, and 96% in 2017 for Turkish children younger than 12 months of age. A total of 499932 pediatric visits were recorded, and AOM was diagnosed in 23005 (4.6%) children. The incidence of AOM in children ≤5 years of age decreased from 10700/100000 (2011) to 4712/100000 (2017), with a significant decreasing trend (p < .001, r = -0.965). When the mean annual incidences of AOM between the transition period of PCV13 (years 2011/2012) were compared with those of a post-PCV13 period (years 2016/2017) for children ≤5 years of age, the incidence of AOM was found to be decreased by 54% (p = 0.013). The mean incidence of TT insertion was found to be decreased by 65% (p = 0.003) between the transition period of PCV13 and a post-PCV13 period for children ≤5 years of age. On the other hand, rAOM incidence was found to be increased in whole pediatric age groups. Our study showed a significant decrease in the incidences of AOM and TT insertion in children ≤5 years old after implementation of PCV13 in the NIP in Turkey.

Congenital muscular torticollis in older children: treatment with Z-plasty technique.

Congenital muscular torticollis (CMT) is a common congenital disorder of the musculoskeletal system in neonates and infants. The aim of this study was to evaluate the results of inferior Z-plasty in older children with CMT. They had mean age of 10 years (range, 5-14 years) and were followed up for 1 to 6 years. Postoperative protocol included a neck exercise program composed of active and passive movements in all cases and immobilization with a cervical collar in only 4 patients. This study concluded that surgical management of older children with CMT using Z-lengthening gives excellent clinical and functional results. The procedure is much more effective than other techniques and relatively complication-free and safe. Postoperative cervical collar and a well-planed physiotherapy protocol go a long way toward ensuring good to excellent results. Early diagnosis and treatment are necessary for good results.

Traumatic thrombosis of internal carotid artery sustained by transfer of kinetic energy.

A 31-year-old male patient with a fatal thrombosis of the internal carotid artery caused by gun shot injury was presented in this case report. The patient was referred to the hospital with a diffuse edema on his left cheek. On otolaryngologic examination, there was a bullet entrance hole at the left mandibular corpus. No exit hole could be found. The finding from his axial computed tomography of neck and paranasal sinuses was normal. On neurological examination, a dense right hemiparesis was observed. In his cerebral angiogram, left common carotid artery was totally obliterated. Diffuse ischemia was observed in the left cerebral hemisphere. Despite intensive interventions, the patient died 4 days after the accident. In the autopsy, a large thrombosis was obtained in the left common carotid artery. This case emphasizes a fatal kinetic energy effect in vascular structures. It is stressed that a gun shot injury could be fatal with its indirect kinetic energy effects at subacute phase.

The physiological impact of high altitude on nasal and lower airway parameters.

The aim of this study was to investigate the impact of high altitude on nasal and lower airway parameters in a healthy population. This was a prospective study of 61 individuals who climbed to the summit of Mount Kackar, at 3,937 m. Peak nasal inspiratory flow rates were recorded in all participants at sea level and at the summit. In 32 participants who ascended to the summit, sea-level and summit peak expiratory flow rates and olfactory function were evaluated. A rise in altitude significantly decreased peak nasal inspiratory flow by a mean of 27.43%. Mean peak expiratory flow values measured at the summit were 8.94% lower than basal values. Between-value differences were statistically significant (p < 0.001, p < 0.05). At high altitude, there was a significant decrease in olfactory function, as determined by a significant reduction in smell detection (p < 0.05) and smell identification (p < 0.05). The effect of high altitude on nasal function was found to parallel that of the effect on lower airway function, together accounting for an adverse effect on airway flow rates. The nasal mucosa responded to high altitude with an increase in airway resistance and a consequent impaired sense of smell.

[Efficacy of local heparinoids on preventing edema and ecchymosis after rhinoplasty]. / Lokal heparinoidlerin rinoplasti sonrasi ödem ve ekimozun önlenmesindeki etkinligi.

OBJECTIVES: In this study, the effect of local heparinoids on prevention of periorbital edema and ecchymosis due to rhinoplasty was investigated. PATIENTS AND METHODS: Twenty patients (12 males, 8 females, mean age 23.3 years; range 19 to 34 years) who had bilateral osteotomy were randomly administered postoperative local heparinoid on one periorbital region, without performing any care in the other one. One and a half centimeter of heparinoid was applied once a day for nine days. The other periorbital region was used as control group. The heparinoid was applied additionally, 8 mg dexamethasone i.v was administered to all patients 30 minutes before the surgery and 24 hours after the surgery. Photographs of each patient which were taken on postoperative days 1, 3, 5 and 9 were evaluated as double-blind by two observers. Scoring was performed according to edema and ecchymosis scales. RESULTS: There was no statistical difference with respect to edema and ecchymosis between local heparinoid treated and control eyes. CONCLUSION: No hypersensitivity to drugs occurred in any patients. After analysing the scores, we observed that heparanoids administered locally was not effective in preventing periorbital edema and ecchymosis after rhinoplasty (p>0.05).

Do comorbidities influence objective and subjective recovery rates of nasal polyposis?

OBJECTIVES: To investigate the clinical and laboratory outcomes both objectively and subjectively in nasal polyposis patients with or without comorbidity (CoM; asthma and allergy). PATIENTS AND METHODS: Thirty-three nasal polyposis patients (13 women and 20 men) were included into the study. Their mean age was 39.23 +/- 9.13 years. CoM(+) and CoM(-) nasal polyposis patients were compared with each other. Evaluations contained endoscopic nasal examination, acoustic rhinometry, rhinomanometry, visual analog scale score of nasal blockage, olfactory function score, respiratory function test, skin prick tests, and paranasal sinus computed tomography. RESULTS: Recovery was statistically significant in all observed evaluations for endoscopic and radiologic staging, nasal obstruction, and sense of smell compared with the first evaluation in all patients regardless of the subgroups. Although objective measurements of respiratory functions did not show any change, clinical improvement was detected in CoM(+) patients with a decrease of need to their antiasthmatic medical treatment. CONCLUSIONS: Results of CoM(+) patients led to no statistical difference when compared with CoM(-) subgroup. When applying predefined nasal polyposis treatment protocol, the polyp patients with CoMs do not need close follow-up compared to the patients without CoMs.

Incontinentia pigmenti: a case report and literature review.

Incontinentia pigmenti (IP) is a rare, X-linked dominant disorder that presents at or soon after birth with characteristic cutaneous signs. The eyes and central nervous system are the next most commonly affected systems. We aimed to describe the ophthalmological, neurological and radiodiagnostic findings of a patient with IP and bilateral retinal detachment. Clinical and laboratory findings of a four-month-old female baby who did not have light fixation and had neurological maturation retardation are presented. Characteristic skin lesions of IP were noted especially at the extremities, bilaterally. On neurological examination, motor and mental maturation were retarded and axial hypotonia was noted. Bilateral retinal detachment was the cause of absent eye fixation noted during ophthalmologic examination, and the detachments were also documented by ultrasonography and magnetic resonance imaging (MRI). Otologic examination was normal. Focal left frontal lobe atrophy, corpus callosum hypoplasia and prominence of right hemisphere were also noted on MRI. MR spectroscopy revealed negative lactate peak at the involved left frontal lobe. Bilateral retinal detachment is a probable finding in IP and patients with neurological symptoms should be investigated for associated sight-threatening ocular pathologies.

The effect of resveratrol in tracheal tissue of rats exposed to cigarette smoke.

OBJECTIVE: The aim of this study was to evaluate the effect of resveratrol on the tracheal tissue of rats exposed to cigarette smoke. MATERIALS AND METHODS: 40 adult Wistar albino rats were divided into four groups for an experiment of 6 weeks. Animals in group 1 were controls (n = 10). Rats in group 2 were exposed to cigarette smoke only, and rats in group 3 received daily intraperitoneal injections of resveratrol (10 mg/kg/d). Animals in group 4 were exposed to both cigarette smoke and intraperitoneal injections of resveratrol. Rats of all groups were sacrificed using cervical dislocation. The tracheas were removed and embedded in paraffin blocks. Sections of 4-5 mum thickness were prepared from the blocks. These sections were stained with hematoxylin and eosin, periodic acid-Schiff, and Alcian blue and viewed with a Leica DFC 280 light microscope. RESULTS: Tracheal sections showed that, in group 2 (cigarette smoke group), there was desquamation of epithelial cells into the tracheal lumen, loss of cilia in the epithelial layer, an increase of goblet cells, activation of serous glands at the submucosa, and cell infiltration. In group 4 (cigarette smoke + resveratrol group), all these findings also existed but only a few sections were affected. It was observed that cigarette smoking caused morphological changes such as epithelial degeneration in the upper airway. These morphological changes were correlated with the amount of toxic substances in the cigarette smoke. CONCLUSION: We found that resveratrol had a preventive role in the histopathological changes caused by cigarette smoking in the rat trachea.

Effect of intranasal estrogen on vocal quality.

The objective of this study was to evaluate the effect of intranasal estrogen therapy on female vocal quality. Thirty-two women who had surgically induced menopause were included into the study group and examined through hall year for this study. Estrogen treatment was proposed to all of the patients. Twenty-three of them accepted the treatment protocols including oral (n=12) (2mg estradiol; Estrofem; Novo Nordisk, Denmark) and intranasal (n=11) (300 mc g 17beta-estradiol; Aerodiol; Servier, Chambray-les-Tours, France) form of estrogen. The rest of patients refused estrogen treatment and those patients constituted the control group (n=9). Vocal changes were evaluated with Voice Handicap Index (VHI) and acoustic analysis of voice variations (fundamental frequency [F0], SD F0, jitter, shimmer, normalized voice energy, and harmonics-to-noise ratio) at baseline and after 1-year follow-up. According to VHI, while voice improvement was not clear in oral estrogen group, it was significant at intranasal estrogen group. Voice quality in patients treated with hormone replacement therapy (HRT) was significantly higher than patients without HRT. But between two treatment groups, there were no any statistical discrepancy. According to acoustic analysis, vocal stability among the women who use HRT was significantly better than those who did not use. Intranasal estrogen exerted the most significant effects on vocal stability. The data of our study support that voice undergoes changes in lack of estrogen in surgically induced menopausal women. Taken together with the relevant studies, while oral estrogen replacement therapy shows a favorable influence on voice quality, it seems to be more pronounced with intranasal estrogen than oral form.

Second primary cancer occurrence on forehead flap after reconstruction of nasal carcinoma.

We reported a case of basal cell carcinoma on the flap which was initially treated with excision of squamous cell carcinoma and forehead flap reconstruction of nasal dorsum. After 8 years of reconstruction, basal cell carcinoma was developed on the flap surface. This may be due to a recurrence, or a second primary tumor, or an activation of a dormant tumor with perturbing factors like surgery. In this report, our purpose was to discuss the possible etiopathogenesis, most appropriate diagnostic procedures, and treatment protocol for a carcinoma of the flap which has been used to reconstruct the previous cutaneous cancer.

Experimental otoacoustic emission and auditory brainstem response changes by stellate ganglion blockage in rat.

INTRODUCTION: To investigate the effect of stellate ganglion (SG) block on hearing in rats. MATERIALS AND METHODS: Sixteen male adult rats were randomly divided into 2 equal groups. Both groups underwent preblock auditory brainstem responses (ABRs) in response to tone bursts at 4, 6, and 8 kHz and otoacoustic emissions in response to distortion products as a function of f2 frequency at 1, 2, 4, and 6 kHz. Local anesthetic (0.2 mL of 2% prilokain) was administered to the left SG of the study group by posterior cervical percutaneous approach for cervical sympathetic blockage. In the control group, 0.2 mL of physiological saline was injected to the left SG. Postblock hearing evaluations were made after 15 minutes of injections. RESULTS: Both Dp-gram and I/O function records suggested that whereas hearing thresholds were not affected in lower frequencies after SG blockage, it tended to increase at higher frequencies. In ABR records, waves I and II showed marked latency shift across all frequencies. The interpeak latency of waves I and II was shortened after blockage. Saline injection did not show any significant ABR or distortion-product otoacoustic emission threshold shift across frequencies at 60, 70, 80, and 90 dB sound pressure level. CONCLUSION: Our data demonstrate that SG block improved the hearing parameters in rats with normal cochlear blood flow. To recommend SG blockage as a treatment option in the vascular pathologies of cochlea, further investigation should assess the efficiency of ganglion blockage in hearing parameters of rats with impaired cochlear blood flow.

Grisel syndrome: nontraumatic atlantoaxial rotatory subluxation.

Grisel syndrome is the subluxation of atlantoaxial joint as a result of infectious or inflammatory processes of the head and neck region. The etiopathogenesis of this clinical entity is not clear yet. Early interventions (antibiotherapy, cervical traction, and immobilization) are critical to avoid catastrophic outcome. Early detection of pediatric atlantoaxial subluxation is essential. It requires a combination of clinical assessment and appropriate radiographic imaging. In this report, we present a clinical and radiologic follow-up of a Grisel syndrome; by this way, we discuss the role of radiology on the diagnosis of this rare entity and preview the relevant literature.

Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment?

We investigated the incidence and co-existence of hearing impairment and renal abnormalities in healthy children with preauricular tags and pits. Study population consists of 13,740 primary school children from routine health check. Thirty-five children with preauricular tags and pits were noted. Control group consisted of 91 patients without pits and tags, who underwent renal ultrasound and were scheduled to pediatric outpatient clinic. Urinalysis, renal ultrasound, otoacoustic emission were performed in both the groups. The prevalence of renal abnormality (1/36; 2.7%) and hearing impairment (1/36; 2.7%) in patients with preauricular tags and pits was similar to that of control group (3/91; 3.2% and 4/91; 4.3%) (P = 0.87, P = 0.64, respectively). According to our results, it is not necessary to investigate hearing or urinary abnormality in patients with preauricular tag or pit, unless there is an association of a syndrome or family history of hearing or renal impairment.

[Treatment algorithm for patients with puberphonia]. / Puberfoni hastalarinda tedavi semasi.

OBJECTIVES: We evaluated the results of treatment for puberphonia and aimed to develop a treatment algorithm for patients with puberphonia. PATIENTS AND METHODS: Sixteen male patients (mean age 21.5 years; range 16 to 34 years) with puberphonia underwent voice therapy (3-10 sessions). Perceptual and acoustic analyses of vocal quality were performed in 12 patients. Perceptual analysis included the Voice Handicap Index (VHI) and videolaryngostroboscopy (VLS) and acoustic evaluations included F0 (fundamental frequency), jitter, shimmer, and NNE (normalized noise energy). RESULTS: Following voice therapy, all scores of the VHI showed significant improvements (p=0.001). There was a significant improvement in vibratory pattern and mucosal wave of vocal cords in VLS evaluation (p=0.004 and p=0.002, respectively). Among acoustic parameters, only the mean F0 showed a significant change from 246 Hz to 134 Hz after treatment (p=0.001). Stabilization of F0 could not be achieved in two patients, one of whom underwent type III thyroplasty. CONCLUSION: The main difficulties encountered in the treatment of puberphonia include stabilization of the attained F0 and widening the frequency range. Implementation of the treatment algorithm through a step-by-step approach provides an objective way of assessing the disease and its management.

Primary mucosa-associated lymphoid tissue lymphoma of hypopharynx.

Mucosa-associated lymphoid tissue lymphomas are low-grade B-cell lymphomas that arise from a number of extranodal sites, including both nonmucosal and mucosal organs such as the hypopharynx. We reported a patient with a primary hypopharynx mucosa-associated lymphoid tissue lymphoma presenting with a swallowing dysfunction and severe throat pain. The clinical, radiologic, and histopathologic findings are presented. The patient was followed up for 5 years and treated with nonspecific antibiotics, chemotherapy, and radiation therapy. Because of prevertebral fascia invasion at the initial presentation, surgical treatment was not preferred. The last biopsies of the hypopharynx revealed no evidence of lymphoid infiltrate. Mucosa-associated lymphoid tissue lymphoma involving the hypopharynx is rare and there is no consensus on its treatment. The treatment protocol is presented and the relevant literature is reviewed.

The effect of dexmedetomidine on middle ear pressure.

OBJECTIVE: Dexmedetomidine is a preferred anesthetic agent in otological surgery because it provides controlled hypotension and good surgical field visibility. The aim of this study was to evaluate the influence of this novel agent on middle ear pressure. STUDY DESIGN AND SETTING: This prospective clinical trial was performed in 60 patients who were scheduled for elective surgery. They received dexmedetomidine or saline infusion for 20 minutes before induction of anesthesia. Tympanometric measurements were recorded for both ears at preoperative, intraoperative, and postoperative states. RESULTS: Mean difference of tympanometric peak pressure from baseline was statistically significant between dexmedetomidine and control group at the 30th minute of operation (24.8 daPa, P = 0.003 for right ear; 20.5 daPa, P = 0.02 for left ear) and at the end of the operation (25.8 daPa, P = 0.01 for right ear; 28.1 daPa, P = 0.004 for left ear). CONCLUSIONS: Dexmedetomidine anesthesia raises the tympanometric parameters, but they never exceed the limits of normal.

The Tinnitus Handicap Inventory: a study of validity and reliability.

Our aim was to compose a Turkish version of the Tinnitus Handicap Inventory (THI). Each of two individuals independently translated and retranslated the English version of the THI, and it was adapted by an expert team. The Turkish version of the THI was completed by 110 tinnitus patients. We assessed the internal consistency and reliability of the Turkish version by Cronbach's alpha. We assessed test-retest reliability with a second investigation in 21 patients. We assessed construct validity by analyzing the patients according to their age and to tinnitus duration. Internal validity was tested by multi-item analysis, to assess item convergence and discriminant validity. We obtained high internal consistency and reliability with the Cronbach's alpha coefficient (0.88) and high intraclass correlation coefficient (ICC, 0.78-0.90). Test-retest correlation coefficient scores were highly significant. The Turkish version of the THI is a highly consistent and reliable measure that can be used in evaluating symptoms in tinnitus patients.

Dexmedetomidine: a novel anesthetic agent for middle ear surgery.

Proper selection of anesthetic technique is important in otologic surgical procedures. In the middle ear microsurgery an anesthetic agent must provide bloodless, good surgical field visibility for safe tympanic membrane reconstruction, safe ossicular reconstruction with respect to the basic anatomic structure of the middle ear. Additionally, no alteration of intratympanic pressure is acceptable during the anesthetic act and after its discontinuation. Consequently, postoperative nausea and vomiting should be minimal after tympanoplasty operations for the stability of tympanic graft and ossicles. Therefore, the anesthesiologist must use a technique that provides a sufficiently deep level of anesthesia with minimal intraoperative movement, rapid emergence, good hemodynamic control and tympanometric stability. Currently, many inhaler and intravenous (IV) anesthesia could be preferred for otologic surgical procedures and they offer ideal intraoperative conditions. Dexmedetomidine is a novel analgesic agent that helps this inhaler or IV anesthesia at preoperative state, postoperative period and during surgery especially for hemodynamic stability. In this article, pharmacocinetic properties of dexmedetomidine were described, its advantages for patients undergoing surgery,related patents and its role in otologic surgery were discussed.