Assessment of intracranial pressure with ultrasonographic measurement of optic nerve sheath diameter on patients undergoing suspension direct laryngoscopy.

PURPOSE: The study aims to examine the effect on intracranial pressure by calculating the optic nerve sheath diameter (ONSD) using ultrasound in patients who underwent suspension direct laryngoscopy. METHODS: Thirty-three patients who underwent suspension direct laryngoscopy were included in this prospective observational study. ONSD measurement was performed using a high-frequency linear probe. The ONSD basal (T0) value was determined using ultrasound in the supine position before the induction. Ultrasonography was used to record ONSD in the Boyce Jackson position (T1) just before inserting the laryngeal blade, in the Boyce Jackson position just before removing the laryngeal blade (T2), and in the supine position (T3) just before extubation. RESULTS: A statistically significant rise (p < 0.001) was seen between the patients' baseline ONSD values and the values at T1, T2, and T3. The optic nerve sheat diameter level recorded prior to withdrawing the laryngeal blade (T2) was considerably greater than the ONSD level calculated instantly before insertion of the laryngeal blade (T1) (p < 0.001). The ONSD value prior to extubation (T3) following the removal of the laryngeal blade was considerably smaller than the ONSD value prior removing the laryngeal blade (T2) (p < 0.001). CONCLUSIONS: This study found that when the laryngeal blade is mounted during the suspension direct laryngoscopy surgery, there is a significant increase in ultrasonographically measured ONSD and increased the ONSD even further during the time the mouth gag was remained in situ. This is the first research to indicate that measuring ONSD with ultrasonography during suspension direct laryngoscopy raises intracranial pressure.

The Effect of Anteriorly Located Sigmoid Sinus on Postoperative Hearing Gains: A Case-Control Study.

There are many studies on the effects of temporal bone anatomical variations on a mastoid pneumatization. Considering the effects of the anatomic variations on mastoid pneumatization, it is considered that many anatomic variations may affect graft success rates and postoperative hearing threshold gains. We aimed to evaluate the effects of various anatomic variations on postoperative hearing gains among patients undergoing tympanoplasty. This retrospective cohort study conducted in a tertiary-care university hospital. This study enrolled 57 patients who underwent primary type 1 tympanoplasty operation using the temporal muscle fascia. The patients were divided into two groups as those with an anteriorly located sigmoid sinus (group 1), and no anatomic variation (group 2). Airway gain values at the frequency range of 250 Hz-8000 Hz and pure tone average (PTA) value were calculated preoperatively and at postoperative sixth month. The gains attained by the patient groups with anatomic variations were compared with group 2. There were significant differences between Group 1 and Group 2 in terms of the airway frequencies of 250, 500, 2000, 4000 Hz, and PTA value. We detected a lesser postoperative hearing gain in patients with an anteriorly located SS. We believe that anatomic variations that may affect middle ear and mastoid cavity may also affect postoperative hearing gain.

Effect of rhinophototherapy on nasal congestion in patients with seasonal allergic rhinitis.

OBJECTIVE: The aim of the present study was to objectively and subjectively evaluate the effects of adding rhinophototherapy to intranasal beclomethasone dipropionate to treat nasal congestion in patients with seasonal allergic rhinitis. METHOD: Seventy-five seasonal allergic rhinitis patients were randomly divided into two groups. Patients in Group 1 received intranasal beclomethasone dipropionate for two weeks and patients in Group 2 had rhinophototherapy added to the same medical therapy as Group 1. The effectiveness of treatments was evaluated with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Nasal Obstruction Symptom Evaluation scale (NOSE) questionnaires and active anterior rhinomanometry. RESULTS: After treatment, significant improvement was observed in Group 2 vs Group 1 in terms of RQLQ (p = 0.011) and NOSE (p = 0.001) scores. In Group 2, significant differences were observed between before and after treatment for inspiratory total nasal resistance (p = 0.004). However, no significant differences vs. baseline were observed in Group 1. CONCLUSION: Our study shows that adding intranasal phototherapy with a combination of UVA, UVB and visible light therapy to nasal beclomethasone dipropionate treatment objectively improves nasal patency in patients with seasonal allergic rhinitis.

Evaluation of cervical vestibular evoked myogenic potential measures using different stimulus types in patients with posterior canal benign paroxysmal positional vertigo.

Background: Cervical Vestibular Evoked Myogenic Potential (cVEMP) measurements still do not have standard normative values in posterior canal benign paroxysmal positional vertigo (BPPV).Aim/Objectives: We aimed to compare cVEMP recordings obtained with different stimuli applied in two different intensities in posterior canal BPPV patients.Methods: Thirty-four patients with unilateral posterior canal BPPV were included in the patient group. In cVEMP recordings obtained with different stimulus intensity [95 dB HL and 105 dB HL] and different stimuli[tone-burst cVEMP (T-cVEMP) and click cVEMP (C-cVEMP)].Results: When the C-cVEMP and T-cVEMP findings were compared in the patient group, differences were observed only in peak-to-peak p1-n1 amplitude values in the measurements performed with 95 dB stimulus. However, T-cVEMP measurements performed with 105 dB stimulus showed that both p1 and n1 latency values ​were longer and peak-to-peak p1-n1 amplitude values ​were higher than C-cVEMP measurements.Conclusions and significance: We recommend using priorly tone-burst stimulus for measurements with 105 dB HL in cVEMP evaluations we will perform in posterior BPPV patients. Both stimulants can be used when 95 dB HL stimuli is used.

Evaluation of the effect of Boyle-Davis mouth gag on intracranial pressure in patients undergoing adenotonsillectomy by using ultrasonographic optic nerve sheath diameter measurement.

OBJECTIVE: We aimed to evaluate the effect of an increase in intracranial pressure (ICP) due to sympatho-adrenergic response caused by mouth gag and tongue depressor during adenotonsillectomy by measuring the optic nerve sheath diameter (ONSD) by ultrasonographic method. METHODS: Forty patients (age range 3-12 years) who underwent adenotonsillectomy were included in the study. All patients underwent surgery under general anesthesia with endotracheal intubation. Boyle-Davis mouth gag was used during the procedure. ONSD measurement was performed and a high-frequency linear probe. All ONSD measurements were performed by a single investigator experienced in the use of ultrasound. Ultrasonographically measured ONSD before induction was accepted as baseline (T0) value. Immediately after insertion of the mouth gag (T1), just before removal of the mouth gag (T2), and just before extubation (T3), ultrasonographic measurements of ONSD were recorded. RESULTS: When patients' baseline ONSD values were compared with the values obtained in T1, T2, T3, and a statistically significant increase was detected. The ONSD value measured before removing the mouth gag (T2) was significantly higher than the ONSD value measured immediately after the insertion of the mouth gag (T1). The ONSD value measured just before extubation (T3) and after removal of the mouth gag was significantly lower than the ONSD value (T2) measured just before removal of the mouth gag. When heart rate, mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) values of T0, T1, T2, T3 were compared, any statistically significant difference was not observed. When end-tidal carbon dioxide level (etCO2) and peak inspiratory pressure (PIP) values of T1, T2, T3 were compared, any statistically significant difference was not observed. CONCLUSION: This study showed that the Boyle-Davis mouth gag used during the adenotonsillectomy operation resulted in a significant increase in the diameter of the optic nerve sheath measured ultrasonographically and increased the ONSD even further during the time the mouth gag was remained in situ. In children with intracranial pathologies who will undergo adenotonsillectomy or those with increased ICP-related risk factors, the risks that may arise from the effect of the Boyle-Davis mouth gag on ICP should be considered.

The relationship of high-frequency distortion product otoacoustic emission (DPOAE) values with hematological parameters in tinnitus patients.

PURPOSE: In this study, we aimed to investigate whether there is any positive or negative correlation between high-frequency distortion product otoacoustic emission (DPOAE) values and mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) in tinnitus patients. METHODS: The study was performed with 52 volunteers (27 females, 25 males) aged between 35 and 50 years who presented with tinnitus to the otolaryngology outpatient clinic of a tertiary care center. Pure voice audiometric examination, DPOAE measurement, complete blood count values of the study participants were examined. RESULTS: In both ears, a significant and negative correlation was observed between 4000 and 8000 Hz airway and 4000 Hz bone conduction pathways with NLR rates (p < 0.05). A statistically significant relationship was found between the bone conduction pathway PTA and discrimination values for both ears and NLR s (p < 0.05). A positive correlation was detected between NLRs and DPOAE measurements recorded at 4444 Hz, 5000 Hz, 8000 Hz, 8889 Hz, 10,000 Hz and 11,429 Hz frequencies in the right and 4444 Hz, 5000 Hz, 6154 Hz, 8000 Hz, 10,000 Hz and 11,429 Hz frequencies in the left ears, respectively (p < 0.05). CONCLUSIONS: We concluded that there is a significant correlation between high-frequency pure tone audiometry measurements and high frequency DPOAE measurements and NLR. Further studies are needed to determine the utility of NLR as a marker for the recognition and follow-up of hearing loss in patients with tinnitus.

Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo.

PURPOSE: The association of vertigo with anxiety disorders is well known. Herein, we aimed to determine the relationship between pre-treatment and post-treatment anxiety levels, assessed with Beck anxiety inventory, with educational status among patients diagnosed with and treated for Benign paroxysmal positional vertigo (BPPV), and to evaluate the effect of treatment on the sub-parameters of the Beck anxiety inventory. METHODS: Our study included a total of 33 patients that presented to the otorhinolaryngology outpatient clinic with acute vertigo and were diagnosed to have posterior canal BPPV. Patients diagnosed with posterior BPPV were applied Beck anxiety inventory prior to the treatment as well as 1 week and 4 weeks after the treatment. RESULTS: Compared to the control group, statistically significant changes were observed in relation to pre-treatment and post-treatment inventory scores (p < 0.05). A comparison of the pre-treatment and post-treatment assessments revealed significant differences (p < 0.05). Improvements were observed in 48% (10/21) of the subparameters by the end of the first week at the earliest. Educational status had no significant effect on inventory scores (p > 0.05). CONCLUSION: Anxiety-related subjective symptoms mostly started to improve 1 week after the treatment at the earliest, and symptoms showed persistence at a certain level even at the end of the first month. Inequalities between the patients' educational levels affect anxiety levels. It should be remembered that educational status should be considered when approaching patients.

The effect of thyroid autoantibody positivity on the functions of internal ear.

The objective of the study is to investigate if any significant difference exists in hearing thresholds and tympanometric examination results among patients whose thyroid antibody positivity was detected approximately 1 year or at least 5 years ago. Study population aged less than 40 years consisted of 17 patients who had thyroid antibody positivities for an average of 1 year (first group), 15 patients who were followed up for at least 5 years for thyroid antibody positivity (second group), and 18 volunteers (third group). Tympanometric examination results, stapes reflex, SRT, SD, and pure tone values were examined. When the second group and the third group were compared, significant results were obtained at hearing frequencies between 500 and 4000 Hz. When the first group and the third group were compared, only at 1000 Hz threshold significant results were obtained. During evaluation of hearing frequencies between 250 and 8000 Hz, significant results were not observed between the second group and the first group. When the first and the second groups were compared with the control group, significant results were obtained as for tympanometric examination findings and significant results were not observed between the second group and the first group. A significant difference was not detected as for the results of stapes reflex. Since thyroid antibody positivity affects the functions of internal ear, these patients should be more closely monitored. Since these effects become deeper in line with increased exposure to autoantibody positivity, variations in auditory responses should be more attentively monitored.

Functions of the inner ear in psoriatic arthritis.

OBJECTIVE: This study aimed to investigate whether there is a negative impact as a result of psoriatic arthritis disease of the inner ear function. METHODS: Twenty-four successive patients and 38 healthy volunteers, younger than 60 years of age, who were followed up for at least for one year in the outpatient clinics of physical therapy and rehabilitation with the diagnosis of PsA according to CASPAR criteria (17) and who did not complain of any hearing impairment were included in the study. Distortion-product otoacoustic emission (DPOAE) values between 1kHz and 4kHz, tympanometric examination results, stapes reflex values, speech reception threshold (SRT) and speech discrimination (SD) values, pure-tone values between 250 and 8000Hz and high-frequency values between 10,000, 12,500 and 16,000Hz were analyzed. Statistical comparisons between both groups were performed using chi-square test and Mann-Whitney U test. p<0.05 was accepted as the level of statistical significance. RESULTS: Our study population consisted of 24 [9 male (37.5%) and 15 female (62.5%)] patients with a mean age of 47.21±11.28 (range, 28-59) years and 38 [16 male (42.1%) and 22 female (57.9%)] healthy volunteers with a mean age of 44.39±8.12 (range, 29-59) years as the control group. Mean duration of arthritis was 7.62±4.88 years. In the evaluation of hearing frequencies of the patients between 4000 and 6000Hz, a statistically significant difference was found relative to the control group (p<005). DPOAE values of the patients were analyzed within the 1000-4000Hz interval. When compared with the control group, a statistically significant difference was found at 3000 and 4000Hz (p<005). CONCLUSION: Our study provides strong evidence suggesting the necessity of monitorization of these patients regarding sensorineural hearing loss so as to take measures against the development of hearing loss during early stage, which may be another disability in patients with PsA, which is itself a potential cause of severe disability.

The impact of topical and systemic enoxaparin sodium use on traumatic tympanic membrane perforation and myringosclerosis.

The objective of this study is to investigate the effect of topical and systemic enoxaparin sodium on the healing pattern of experimentally induced tympanic membrane perforation and formation of myringosclerosis. A total of 24 Wistar-Albino strain rats were included in the study. Standard myringotomies were performed on each rat. In the first group, isotonic serum physiologic was dropped on external ear canal (control group). Topical enoxaparin was dropped on external ear canal and daily topical doses of enoxaparin were dropped on external ear canal of the rats for 14 days (topical treatment group). Third group received subcutaneous injections of enoxaparin for 14 days (systemic treatment group). Five micrometer thick sections of the bullae of the rats were stained with H&E. Inflammation, edema and sclerotic lesions and neovascularization observed in the lamina propria layer of the tympanic membrane, and total thickness of the tympanic membrane were evaluated. In intergroup comparisons, significant difference in the distribution pattern of severity of inflammation in all three groups was not observed (p = 0.784, p > 0.05). Total TM thickness differed among all three groups (p = 0.028, p < 0.05). A statistically significant difference was observed between the systemic enoxaparin and the control groups (p = 0.022, p < 0.05). A statistically significant difference was observed between the topical enoxaparin and the control groups (p = 0.037, p < 0.05). However, comparison between the topical and systemic treatment groups could not reveal any statistically significant intergroup difference (p = 0.682, p > 0.05). A significant difference was not observed among three groups as for the distribution of myringosclerotic plaques, severity of edema and neovascularization in the lamina propria (p = 0.539, p > 0.05), (p = 0.063, p > 0.05), (p = 0.152, p > 0.05). Topical and systemic enoxaparin treatment did not prevent formation of sclerotic plaques; however, it decreased TM thickness significantly in comparison with the control group.

The Impact of Systemic and Local Administration of Ascorbic Acid on Traumatic Perforation of Tympanic Membrane and Myringosclerosis.

OBJECTIVE: In the present study, tympanic membranes (TM) harvested from myringotomized rats were analyzed histopathologically to compare the systemic and local effects of ascorbic acid on the development of myringosclerosis. MATERIALS AND METHODS: Forty male Wistar-Albino rats weighing between 350-400 g were included in this study. Under otomicroscopic examination, a standard 2-mm myringotomy incision was made on the posteroinferior quadrant of the TM of both ears. Rats were randomized into five groups as control, topical ascorbic acid 50 mg/kg, systemic ascorbic acid 50, 100, and 200 mg/kg groups, each group containing eight rats. On the 15th day of the study, the rats were decapitated, and bullas of the rats were extracted. Sections were stained with hematoxylin-eosin and examined through light microscopy. Inflammation, distribution width of plaques, edema, and neovascularization were observed on the lamina propria. Thickness of the TM was evaluated under the microscope and scored semiquantitatively. RESULTS: When intergroup comparisons of parameters related to total TM thickness were performed, differences between the control group and topical AA (ascorbic acid) or systemic treatment groups were found to be statistically significant (p<0.005). A statistically significant difference was detected among control, topical and systemic 200 mg/kg ascorbic acid groups for the edematous lamina propria (p=0.003 and p<0.05, respectively). CONCLUSION: For the total TM thickness, systemic and topical ascorbic acid use was effective when compared with the control group. It has been concluded that systemic use of higher doses of (200 mg/kg) ascorbic acid is beneficial in the resolution of the edematous lamina propria.