Sudden hearing loss associated with methylphenidate therapy.

An 8-year-old child diagnosed with attention deficit/hyperactivity disorder presented to our Department of Otolaryngology 4 days after suffering hearing loss, loss of balance, tinnitus, and fullness sensation of the left ear. Her symptoms occured with the first dose of methylphenidate. The medical history and physical examination revealed no other diseases associated with sudden hearing loss. The audiogram revealed a total hearing loss on the left ear. Stapedial reflexes, distortion product and transient-evoked otoacoustic emissions were absent in left ear. The absence of clinical, laboratory and radiological evidence of a possible cause for complaints, an association between methylphenidate and sudden hearing loss was suggested. The patient received a standard course of oral corticosteroid and hyperbaric oxygen therapy. Weekly otological and audiological examinations were performed. Conservative and medical treatments offered no relief from hearing loss. Sudden hearing loss is a serious and irreversible adverse effect of methylphenidate. Therefore, the risk of hearing loss should be taken into consideration when initiating methylphenidate therapy.

The course of the marginal mandibular branch of the facial nerve in adult cadavers. An anatomic study.

OBJECTIVE: To observe the course of the marginal mandibular branch of the facial nerve (MMBFN) and its relation to the inferior border of the mandible and facial vessels. METHODS: This cadaveric study was conducted at the Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey from April to September 2012. The 44 facial halves of 22 adult cadavers were dissected under a stereomicroscope. RESULTS: The nerve was found to be presented by one branch (36.4%), and 2 branches (63.6%). The distance of the nerve from the inferior border of the mandible varied from 13.06-40.08 mm, with an average distance of 21.91 mm. There were communications with buccal branch only in 2 specimens (4.6%). All the branches of the marginal mandibular branch ran laterally to the facial artery in 43 (97.7%) of the 44 specimens. In one specimen, the 2 marginal mandibular branches ran between the facial artery and vein. CONCLUSION: The MMBFN can occasionally be damaged during surgeries confined to the submandibular region due to its location and anatomical variant. The most common pattern of MMBFN was nerve with 2 branches. The maximum distance between the MMBFN and the mandible was 40.08 mm. This anatomical knowledge may be useful to surgeons of the head and neck in planning incisions and procedures in the submandibular region.

Middle ear ventilation function in patients with myringoplasty alone and myringoplasty plus mastoidectomy.

OBJECTIVES: In this study we investigated the correlation between middle ear pressure changes in patients with myringoplasty alone and together with intact canal wall mastoidectomy. PATIENTS AND METHODS: The tympanometric values of 102 patients with myringoplasty alone and 78 patients with myringoplasty plus intact canal wall mastoidectomy were examined by tympanometric analysis in this retro-prospective study. The study population consisted of 130 male and 50 female patients (mean age 25.3±7.7). All patients underwent myringoplasty with or without mastoidectomy due to chronic otitis without cholesteatoma. Patients with a value of less than -100 daPa during the postoperative follow-up were considered having normal middle ear ventilation. Independent-samples t-test was used for comparison of the analyses results of groups. RESULTS: Sixty patients with myringoplasty (58.8%) and 55 patients with intact canal wall mastoidectomy (70.5%) had middle ear pressures less than -100 daPa at three months after surgery. The percentage of recovery over the first three years was 70.5% and 76.9% in the myringoplasty and intact canal wall mastoidectomy groups, respectively. The rate of persistent negative pressure is 21.6% and 14.1% in the myringoplasty and intact canal wall mastoidectomy groups, respectively. The number of patients who had negative middle ear pressure in myringoplasty group was higher than the number of those in intact canal wall mastoidectomy group at all intervals. However, when the rate of normalization over time was compared between two groups, no significant difference was found (p>0.05). CONCLUSION: In first three months, the significantly higher number of patients achieving normal middle ear ventilation in mastoidectomy group compared to the patients without mastoidectomy is a finding which supports the additional effect of mastoidectomy on the pressure normalization function. However, the rate of normalization over time is not different between two groups. Middle ear pressure normalization is a continuous dynamic process and improvements may be seen for up to one year.

When to manage level V in head and neck carcinoma?

OBJECTIVES/HYPOTHESIS: As superselective neck dissection strategy is gaining popularity to minimize postoperative morbidity and better life quality, we investigated the metastatic nodal status of level V neck lymph node group for head and neck squamous cell carcinoma in various primary sites. We have also aimed to display the impact of involvement of other nodal groups on level V. STUDY DESIGN: Retrospective review of histopathologic examination of case series at a comprehensive cancer center. METHODS: The study group was composed of 107 patients who underwent a type of neck dissection including level V among 243 patients. The impact of primary site and metastatic nodal status of other levels on metastasis to level V involvement were evaluated. RESULTS: The most common primary tumor site was oropharynx (n = 43), followed by oral cavity (n = 32), larynx (n = 16), carcinoma of unknown primary (n = 10), and hypopharynx (n = 6). General pathologic N positivity for all levels was 78.3% (76 of 97) when 10 carcinoma of unknown primary patients were excluded. Level V was involved in 13 of 107 (12.1%) patients. Level V was not involved in any patient when the other levels were not involved (0 of 21). Even when considering only N+ patients, the ratio of N positivity for level V is still <20% (13 of 86, 15.1%). CONCLUSIONS: Because level V was not involved in any patient when the other levels were not involved, it might be reasonable to preserve level V especially in clinically and intraoperatively N0 patients.

When to address level I lymph nodes in neck dissections?

OBJECTIVE: To investigate the involvement of level I neck lymph node groups in head and neck carcinoma and compare the effect of primary tumor sites, such as oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (Lx), on level I lymph node metastasis. STUDY DESIGN: Case series with chart review. SETTING: Comprehensive Cancer Center. SUBJECTS AND METHODS: A total of 243 patients with OC and laryngopharyngeal carcinoma who underwent neck dissections in the last three years were included in the study. The primary tumor site was OC, followed by OP, Lx, HP, and carcinoma of unknown primary (CUP). RESULTS: Level I was involved in 29 of 243 (11.9%) patients. The other levels were also positive in all but five (17.2%) level I-involved patients. The primary tumor site with level I lymph node metastasis was OC (19.1%), followed by CUP (11.1%), OP (9.8%), Lx (4.4%), and HP (0%). The Lx primary site involved level I only if there were multiple other adverse prognostic features, such as N3 neck, extracapsular spread, pathologic involvement of all resected lymph nodes, involvement of all levels I-V, and invasion of the submandibular gland. CONCLUSION: Although the submandibular content is resected as part of radical and modified radical neck dissections, level I-sparing selective neck dissections could be a safe and effective surgical neck management strategy in appropriately selected patients with OP, Lx, and HP carcinoma.

Management of tympanosclerosis with ossicular fixation: review and presentation of long-term results of 30 new cases.

OBJECTIVE: Surgery for tympanosclerosis has always been challenged with the risk of deterioration of hearing or the recurrence of the disease. If surgery is indicated, controversy exists regarding staging versus nonstaging and whether to perform stapedectomy or mobilize the fixed ossicles by removal of plaques. The aim of this study was to review the previous reports and to analyze the long-term surgical outcome of 30 patients who have been operated on owing to tympanosclerosis. METHODS: Nine hundred twelve cases with chronic otitis media with or without cholesteatoma that have undergone either the intact canal wall or canal wall down mastoidectomy technique were analyzed retrospectively. Thirty patients who underwent ossicular chain reconstruction between 1990 and 2005 owing to conductive hearing loss resulting from tympanosclerosis were selected after excluding those patients who had repair of a sclerotic eardrum only. The types of surgery for restoration of hearing loss, postoperative hearing gain, and closure of air-bone gaps were compared. The average follow-up was 4.3 years. RESULTS: There were 19 male and 11 female patients, with ages ranging between 12 and 48 (27.6 +/- 9 years). Fourteen patients (47%) underwent myringoplasty and ossiculoplasty only, 14 patients (47%) had simple mastoidectomy, and 2 patients (6%) had a modified radical mastoidectomy owing to associated cholesteatoma. Seven patients with advanced tympanosclerosis had stapedectomy and a total ossicular replacement prosthesis (TORP), five patients had stapes mobilization and a partial ossicular replacement prosthesis (PORP), two patients had incus transposition, one patient had a tragal cartilage graft over the stapes as ossicular reconstruction, and one patient had a graft over the incus. Fourteen patients with an intact ossicular chain had a mobilization procedure associated with mastoidectomy and atticotomy. Thirty-three percent of the patients had less than 20 dB air-bone gaps in the long term. Patients with stapedectomy with TORP and PORP application presented with better air-bone gap closure (to 20 dB) compared with those with the mobilization procedure only. None of the patients had a dead ear after surgery. CONCLUSION: The success of the surgery was dictated by the location and the extent of tympanosclerotic involvement. Controversy still remains concerning the long-term results of the surgical management of tympanosclerosis, and the results are not satisfactory, as seen in surgery for otosclerosis.

Hypoglossal-facial nerve anastomosis: a meta-analytic study.

OBJECTIVES: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. METHODS: Articles were identified by means of a PubMed search using the key words "facial-hypoglossal anastomosis," which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. RESULTS: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. CONCLUSIONS: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.