Comparison of surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery.

OBJECTIVE: The main objectives of the present study were to compare the surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery. METHODS: Sixty-one patients who underwent the stapes surgery with the endoscopic and microscopic approach between January 2012-November 2018 were included in the study. Patients were divided into two groups as a Group-I (endoscopic) and Group-II (microscopic). The audiometric measurements, duration of surgery, intraoperative findings and complications were recorded and evaluated retrospectively. RESULTS: Mean operative time for the Group-I and II was 45.1±8.4 minutes and 48.7±5.6 minutes, respectively (p>0.05). The preoperative and postoperative average air-bone gap in the Group-I was 27.8±7.2 dB and 8.7±3.4 dB and these values in Group-II were 30.2±5.1 dB and 7.4±4.8 dB, respectively (p<0.001). The requirement of chorda tympani nerve manipulation and scutum curettage were significantly less in Group-I as compared Group-II (p<0.05). Dysgeusia and postoperative pain were observed significantly higher ratios in Group-II relative to Group-I (p<0.05). There was no significant difference between endoscopic and microscopic approach in stapes surgery in terms of difficulty of prosthesis insertion (p>0.05). CONCLUSION: Endoscopic stapes surgery provides comparable audiological outcomes, shorter operative times, fewer complications rates, and more minimally invasive surgery, relative to the microscopic approach.

Repair of Cerebrospinal Fluid Leak in Cochlear Implantation.

OBJECTIVE: The aim of this study is to evaluate the treatment of cerebrospinal fluid (CSF) leaks from cochleostomy after cochlear implantation intraoperatively and postoperatively. METHODS: Three hundred seven patients (age ranges 13 months to 18 years) were undergone cochlear implantation and 14 (4.56%) of them had CSF leakage intraoperatively (2 normal, 12 anomalous cochlea). Complete packing of the around electrode in cochleostomy with muscle had performed to control CSF leak intraoperatively for primary surgery in 10 patients. Cerebrospinal fluid leakage was observed in 3 patients after cochlear implantation postoperatively. Revision surgeries for CSF leakage with fat tissue sealing were performed for them also. Fat tissue packing was performed for the last 4 patients in primary surgery. Outcomes of management methods for sealing were evaluated. RESULTS: Sealing the cochleostomy with muscle was performed for 10 patients. Fibrin glue applications were used for excessive leakage for 5 patients with cochlear anomalies and 3 of these patients had CSF leak from cochleostomy postoperatively (Patients I, II, III). Secondary surgeries with fat tissue sealing were performed. But CSF leakage also was occurred in Patient III. Subtotal petrosectomy and obliteration of cavity with fat tissue had been performed for Patient III. Cerebrospinal fluid leakage has not been seen in primary surgeries with fat tissue packing in other 5 patients. CONCLUSION: Cerebrospinal fluid leakage may occur in cochlear implantation patients with inner ear anomalies postoperatively. Sealing of the cochleostomy with fat tissue is more useful than muscle intraoperatively.

Outcomes of cochlear implantation in children with and without inner ear malformations.

OBJECTIVE: To evaluate the auditory functions and progress of speech development in children with and without cochlear anomalies who underwent cochlear implantation due to prelingual profound sensorineural hearing loss (SNHL). METHODS: This study was conducted at Gaziantep University Faculty of Medicine Ear-Nose-Throat Department, between October 2006 and December 2007. A total of 69 children (aged 6 to 24 months) diagnosed with profound SNHL were included. Patients were divided into two groups with respect to the presence of inner ear anomalies: Group-1 consisted of 41 children without inner ear anomaly, whereas Group-2 was composed of 28 patients with inner ear anomalies. The auditory performance was assessed using Listening Progress Profile Test (LPPT) and Monosyllabic Trochee Polysyllabic Test (MTP), the subsections of Evaluation of Auditory Responses to Speech (EARS) test battery. RESULTS: Preoperative LPPT scores were 5 (12%) in both groups. Mean LPPT values after fitting in Group-1 and Group-2 on 1st, 3rd and 6th months were 18.5 (44.1%) and 19 (45.6%); 27 (64.2%) and 28 (67.3%); 31 (75%) and 34 (83%), respectively. Postoperatively, MTP scores in Group-1 and Group-2 were 7.5 (62%) and 7.7 (64%) for 3-words set; 10.4 (58%) and 10.6 (59%) for 6-words set; 14.3 (60%) and 14 (59%) for 12-words set, respectively. The rate of stimulation for electrodes was 1345 q/u (quick/unit) in Group-1 and 1310 q/u in Group-2. No statistically significant difference was detected between groups for variables under investigation. CONCLUSION: Cochlear implantation is an effective treatment in children with prelingual profound SNHL. Auditory performance and advancement of speech are similar for children with and without inner ear anomalies.

Regional differences of Turkey in risk factors of newborn hearing loss.

OBJECTIVE: The aim of this study was to discover Turkish regional differences in the risk factors of newborn hearing loss. METHOD: A multi-centered retrospective design was used. A total of 443 children, registered to the national newborn hearing screening programme, with bilateral hearing loss, from five different regions of Turkey, were evaluated in terms of the types of hearing loss, the degree of hearing loss, the types of risk factors, parental consanguinity, age at diagnosis and age of auditory intervention, respectively. RESULTS: There was no significant difference in the prevalence of hearing loss between regions (χ2 = 3.210, P = 0.523). Symmetric Sensorineural Hearing Loss (SSHL) was the most common type of HL in all regions (91.8%). Profound HL was the most common degree of HL in all regions (46.2%). There were statistically significant differences between regions in terms of types of HL (χ2 = 14.151, P = 0.000). As a total, 323 (72.9%) of subjects did not have any risk factors. There were statistically significant differences between regions in terms of the types of risk factors (pre, peri and post-natal) for SSNHL (χ2 = 16.095, P = 0.000). For all regions, the age of diagnosis was convenient with the JCIH criteria. However the age of hearing aid application was prolonged in some regions. There were statistically significant differences between regions in terms of the age of diagnosis (χ2 = 93.570, P = 0.000) and the age of auditory intervention (χ2 = 47.323, P = 0.000). The confounding effects of gender, age of diagnosis, age of hearing aids applications, HL in the family, types of risk factors for HL on SSNHL were detected. CONCLUSION: To reach the goal of a high quality newborn hearing screening, there is a need to develop an evidence-based standard for follow up guideline. In addition, risk factors should be re-evaluated according to regional differences and all regions should take their own precautions according to their evidence based data.

The protective role of molsidomine on the Cisplatin-induced ototoxicity.

This experimental study was designed to investigate the protective effects of molsidomine (MOL) on against cisplatin-induced ototoxicity (CIO). To examine this effect, distortion product otoacoustic emissions (DPOAEs) measurements and serum levels of oxidative and antioxidant status [including malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GPX), total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI)] were evaluated. Thirty-two female wistar albino rats were divided into four groups including; control (Group K), cisplatin (Group C), cisplatin plus MOL group (Group CM), and MOL group (Group M). DPOAEs measurements between 0.9961 and 8.0003 Hz as DP-gram and input/output (I/O) functions were performed in the same (left) ear of all rats on days 0, 1st, 5th and 12th. Prior to death, the last DPOAEs measurements and blood samples were taken. In the C group, statistically significant DPOAE amplitude reductions were detected at 2.5195, 3.1758, 3.9961, 5.0391, 6.3516 and 8.0039 Hz frequencies (p < 0.05) between 0th and 1st, 0th and 5th and 0th and 12th days' measurements (p < 0.05). Serum level of MDA, TAC and OSI levels were significantly higher in the C group versus K group (p < 0.05). In the CM group, there were no significant differences at all frequencies between 0th and other days' measurements (p > 0.05) and the serum levels of all biochemical parameters were shifted toward normal values, similar to the K group (p < 0.05). No significant differences were detected in the either M or K group's measurements. According to these results, cisplatin-related ototoxicity has been significantly prevented by MOL.

Effects of topical phenytoin on nasal wound healing after mechanical trauma: An experimental study.

OBJECTIVES/HYPOTHESIS: Impaired postoperative wound healing is the second most common morbidity after synechia formation in endoscopic sinus surgery. The aim of this experimental study was to investigate the potential effects of topical phenytoin on wound healing after nasal mucosal trauma in rats. STUDY DESIGN: An experimental study at the Inonu University Faculty of Medicine. METHODS: Twenty-four rats were randomized into three groups: 1) phenytoin group (n = 8), 2) control group (n = 8), and 3) vehicle group (n = 8). After damaging the right nasal cavity, in the phenytoin group, 1% topical phenytoin cream was applied for 7 days. The rats in the control group did not receive any treatment. The vehicle group was treated with daily topical cold cream for 1 week. The rats were sacrificed at the end, and the nasal cavities were excised. Tissue edema and inflammatory cell infiltration were compared among the groups. Additionally, proliferating cell nuclear antigen (PCNA) and cluster of differentiation 31 (CD31) immunoexpression levels were evaluated. Furthermore, in biochemical analysis, the tissue levels of vascular endothelial growth factor and (EGF) of the groups were investigated. RESULTS: In the phenytoin group, tissue edema and inflammatory cell infiltration were significantly decreased, and PCNA and CD31 immunoexpression levels were more prominent (P < .001) and the tissue EGF levels were significantly higher (P < .01). CONCLUSIONS: Topical phenytoin treatment may alter the nasal wound healing after mechanical trauma. The potential beneficial effects of topical phenytoin on nasal mucosa should be investigated by further experimental and human trials. LEVEL OF EVIDENCE: NA.

Congenital aplasia of the external ear canal and total dehiscence of mastoid-tympanic segment of the facial nerve as a cause of recurrent facial paralysis.

Facial nerve (FN) macrodehiscence, in contrast to microdehiscence, generally occurs as a result of chronic otitis media and is rarely seen congenitally. A patient with normal hearing who had no history of ear disease or ear operation came to the clinic with recurrent facial paralysis (FP) and frequent blockage of the external ear canal with epithelial debris complaints. In the explorative ear surgery, we observed that the posterior wall of the external ear canal or tympanic ring was absent, a large external ear cavity was covered with a thin skin, the FN was under the skin, and the tympanic-mastoid segment of the FN and chorda tympani extending to the stylomastoid foramen was completely open. FP episodes were associated with the unprotected FN.To prevent an attack of FP, and to self-clean the external ears, mastoid obliteration surgery was performed, and the mastoid segment of the FN was covered with a conchal cartilage graft. This case was diagnosed as congenital aplasia of the external ear canal due to the tympanic bone aplasia-mastoid bone hypoplasia, and the dehiscence of the mastoid-tympanic segment of the FN, and as a cause of recurrent FP, has never to date been identified.

Well-differentiated neuroendocrine tumor: a rare tumor of the larynx.

Neuroendocrine tumors of the larynx are rarely seen neoplasms. Atypical carcinoid tumor is the most common type of the neuroendocrine tumors of the larynx, whereas the typical carcinoid tumor is the most infrequent type. Preferable treatment in typical carcinoid tumor is particularly conservative surgery without neck dissection. Radio-chemotherapy is ineffective. In this report, we present a 61-year-old female case of typical carcinoid tumor of the larynx with histological findings and applied treatment modality.

Does dexmedetomidine affect intraoperative blood loss and clotting tests in pediatric adenotonsillectomy patients?

BACKGROUND: We hypothesize that dexmedetomidine (DEX), a selective α(2) adrenergic receptor agonist, may affect the intraoperative blood loss and clotting tests such as prothrombin time, activated partial thromboplastin time, and international normalized ratio in children undergoing adenotonsillectomy (ADT). METHODS: Sixty patients scheduled for elective ADT under general anesthesia. The patients were randomly assigned to receive either DEX 0.5 µg/kg (group D) or placebo bolus (group C) with a total volume of 10 mL, 10 min before the induction of anesthesia. Mean arterial pressure (MAP), heart rate, blood loss, preoperatively and immediately after awakening clotting tests, agitation, sedation, visual analog scale, and analgesic requirement, were assessed and recorded. RESULTS: The postoperative hemoglobin was significantly lower than the preoperative value in both groups (P < 0.05). The postoperative agitation scale and analgesic requirement and visual analog scale at the 15th min were significantly lower in group D than those in group C (P < 0.05). Total blood loss and postoperative sedation score in group D was significantly higher than that in group C (P < 0.05). The postoperative prothrombin time, activated partial thromboplastin time, international normalized ratio tests between the groups, additionally pre-postoperative MAP, heart rate, and clotting tests were similar in each group. CONCLUSIONS: The premedication with DEX 0.5 µg/kg decreased postoperative agitation, pain, and analgesic requirement without significant change in the clotting tests and MAP but increased bleeding slightly during ADT.

All concha bullosa: an undefined abnormality of the lateral nasal wall.

Pneumatization of the turbinates, are the anatomic variations of lateral nasal wall. Turbinate pneumatization, refers to the existence of air cell inside the turbinates. Pneumatization of the middle turbinate is common, whereas rare in the superior and especially inferior turbinate. In this report we presented a case who has bilaterally pneumatization of all conchas.

Protective effects of resveratrol on salivary gland damage induced by total body irradiation in rats.

OBJECTIVES/HYPOTHESIS: One of the most common acute side effects of irradiation is xerostomia, which results from damage to the salivary gland cells by direct ionization. Resveratrol is a natural compound with profound anti-inflammatory and antioxidant properties. The purpose of the present study was to investigate the potential protective effects of resveratrol on injury to the salivary glands of rats that were exposed to total body irradiation. STUDY DESIGN: An experimental study at the Inonu University School of Medicine. METHODS: Twenty-nine female rats were randomized into four groups: group 1, high-dose (100 mg/kg) resveratrol group (n = 7); group 2, low-dose (10 mg/kg) resveratrol group (n = 7); group 3, control (vehicle) rats (n = 7); and group 4, sham-irradiation group (n = 8). The medications were administered as single doses, and the rats were exposed to total body irradiation 24 hours after the treatment. The animals were sacrificed the following day, and the parotid and submandibular glands were excised. Salivary gland histology and the tissue levels of glutathione (GSH), nitric oxide (NO), and malondialdehyde (MDA) were investigated. RESULTS: The rats in group 1 showed significantly decreased acinar loss and less ductal damage and cell necrosis than those of the control group (P < .05). Antioxidant GSH levels were significantly increased by high doses of resveratrol treatment. The tissue activities of MDA in both the parotid and submandibular glands were significantly reduced in group 1. Low-dose resveratrol treatment did not significantly alter the tissue levels of MDA. CONCLUSIONS: Resveratrol at relatively high doses can reduce the irradiation-dependent salivary gland damage, suggesting that this natural antioxidant may be effectively used to lessen the side effects related to salivary gland dysfunction that is induced by irradiation.

Intra- and postoperative electrically evoked stapedius reflex thresholds in children with cochlear implants.

OBJECTIVES: The aim of this study was to investigate whether there is a significant correlation between intra- and postoperative electrically evoked stapedius reflex thresholds (eSRTs) in children with cochlear implants. METHODS: Sixty-five pediatric cochlear implant users were included in this study. All patients had congenital prelingual hearing loss. The round window approach was used in all patients. The eSRTs were intraoperatively measured using the 1st, 3rd, 6th and 12th electrodes of the cochlear implant. The measurements taken during the first fitting of the device were taken again one month after surgery. We used paired-sample t-tests to determine the correlation between intra- and postoperative eSRTs. RESULTS: The eSRT analysis revealed a statistically significant difference between the intra- and postoperative thresholds. A correlation analysis did not reveal any correlation between intra- and postoperative eSRTs. CONCLUSION: Intraoperative eSRT measurements were unable to predict early postoperative eSRTs.

The comparison of acoustic and psychic parameters of subjective tinnitus.

We aim to assess the correlation between audiometric data, and psychotic and acoustic measures associated with subjective tinnitus (ST) and to clarify the importance of the psychological process in determining the degree of subjective annoyance and disability due to tinnitus. Fifty-four patients experiencing unilateral ST were allocated for the study. Acoustic assessment of patients including LDL (loudness discomfort levels), MML (minimum masking level) and RI (residual inhibition) was performed. Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI) and Visual Analog Scale (VAS) tests were performed for the psychological aspects of subjective annoyance. RI was positive in 23 patients with 13 frequency-matched stimuli at 8,000 Hz. Masking treatment response was successful in 16 RI-positive patients. Mean and standard deviation (SD) of THI scores were 38.77 ± 23.63. Ten patients (%18.51) with tinnitus had ≥ 17 points score, which was significant for BDI. Mean and SD were 5.01 ± 2.31 for VAS-1 scores (severity of tinnitus), 7.98 ± 2.79 for VAS-2 (frequency and duration of tinnitus), 5.77 ± 2.72 for VAS-3 (discomfort level), 3.56 ± 3.30 for VAS-4 (attention deficit) and 3.31 ± 3.31 for VAS-5 (sleep disorders). A significant correlation was found between the tinnitus duration time, age, gender and THI scores (P < 0.05). There were statistically significant correlations between VAS 1, 2, 3 scores and LDL, MML and RI (P > 0.05). RI might be largely frequency dependent and was found as an indicator for the masking treatment response. We did not notice statistically significant correlations between audiometric data and THI and BDI. There were correlations between with VAS and LDL and with MML and RI. VAS was simpler and easier for the assessment of ST. We should consider the psychological aspects of ST and assess it as a symptom separately with acoustic and psychotic tests.

Intraoperative electrically evoked stapedius reflex thresholds in children undergone cochlear implantation: round window and cochleostomy approaches.

OBJECTIVES: To study the best electrically stimulation in cochlear implant surgery with round window (RW) and Promontory cochleostomy approaches with electrically evoked stapedius reflex thresholds (ESRT) intraoperatively. METHODS: Thirty-nine children underwent CI surgery were included for this study. The surgical procedures consisted of RW and Promontory cochleostomy. ESRT for each 1st, 3rd, 6th and 12th electrodes (E) were determined. Statistical evaluation was done for the comparison of the thresholds and duration times for both groups. RESULTS: The duration times of ESRT for E1, E3, E6 and E12 electrodes was shorter in RW group compared with the Promontory group (p<0.05). The statistical evaluation of ESRT measurements of E1, E3, E6 found p<0.001 and E12 electrode p<0.05 in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. CONCLUSION: The duration of electrically stimulation thresholds were shorter in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. RW insertion offers best electrically stimulation relative to electrode insertion via a promontory cochleostomy.

Use of rotation flap in repair of cleft palate and velopharyngeal insufficiency.

Although cleft palate anomaly is frequent, the criterion standards in surgical treatment have not been determined yet. There are a few techniques described for cleft palate repair owing to the limited tissue in the palatal mucosa, the rigid structure of the palatal mucosa, and the limited vascularity of the hard palate. In this study, a novel cleft palate repair technique based on separating the soft palate from the hard palate as a musculomucosal flap and using it as a rotation flap has been described. The operation is evaluated individually for each anomaly because variations occur in the surgical technique according to the extension of the cleft toward the teeth in the palate. This operation was performed on a total of 28 patients (17 girls and 11 boys) aged between 1.5 and 16 years and presented to our clinic. Patients were assessed for speech analysis outcomes, tympanogram values, hearing functions, magnitude of palatal lengthening during the operation, and rate of fistulae. Statistically significant differences in values of the speech analysis and the audiometric assessment were determined between before and 6 months after surgery. Complete recovery of otitis was observed 1 month after surgery without another treatment in 9 (42.8%) of 21 patients who were detected to have serous otitis media preoperatively. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all types of cleft palate, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this technique.

Comparison of the coaxial circle circuit with the conventional circle circuit.

OBJECTIVE: The coaxial circle system helps prevent heat loss during surgery, and it also acts as a humidifier. This study aimed to compare the coaxial breathing system and the conventional system in their ability to warm and moisturize inhaled gases, and we also analyzed lung function protection and saccharin clearance time in patients who underwent tympanomastoidectomy (TMT) with the aid of these two systems. MATERIALS AND METHODS: Forty adult patients of ASA physical status I-II were scheduled for elective TMT. A standard volume-dependent ventilator setting was used to establish normocapnia. The coaxial circle system was used in the treated group (n=20), whereas the conventional circuit system was used in the control group (n=20). Saccharin clearance, VC (vital capacity), FRC (functional residual capacity), FEV1 (forced expiratory volume in 1 second), airway pressure, relative humidity and temperature of inspired gas, body temperature and adverse and hemodynamic effects were measured at different perioperative periods. RESULTS: The relative humidity (mg H2O Lt -1) of inspired gas in the treated group was higher than in the control group at 5, 15, 30, 45, 60 and 90 minutes after anesthesia induction. The temperature of inspired gas (Centigrade) in the treated group was higher than in the control group (p<0.05) after 5, 10, 15, 30, 45, and 90 minutes of anesthesia. Postoperative saccharin clearance time was lower than before the operation in the treated group (p<0.05). Postoperative FRC was lower than preoperative FRC in the study and control groups (p<0.05). CONCLUSION: The coaxial circle system decreased postoperative saccharin clearance time and increased postoperative FRC, relative humidity and the temperature of inspired fresh gas, without any adverse perioperative effects in patients who underwent TMT.

Electrophysiologic assessment of the subclinical changes in facial functions after parotidectomy.

OBJECTIVE: Our objective was to evaluate whether there was a subclinical change in the functions of the facial nerve after parotidectomy. METHODS: Facial nerve functions of 21 patients who had parotidectomy between January 1999 and December 2003 were assessed using electromyography (EMG) at least 5 years after the surgery. RESULTS: There was no significant difference between both sides of the face in the EMG amplitudes (P > 0.05) except for the amplitudes obtained from the site of nasolabial sulcus (P < 0.05). In the patients who underwent total parotidectomy, the EMG amplitudes were significantly different for both sides of the face (P < 0.05). No significant difference was found in the comparison of other measurements performed by EMG. CONCLUSIONS: Tumor histopathologic type (benign or malignant) and type of parotidectomy (superficial or total) do not cause a subclinical dysfunction of the facial nerve after parotidectomy in the patients who also have clinically normal facial functions. The only exception to this contention is the subclinical dysfunction in nasal branches of the facial nerve in total parotidectomy cases.

Alveolar soft part sarcoma of the tongue.

Alveolar soft part sarcoma is a rare type of sarcoma that usually affects young adult women. It occurs mostly in the lower extremities, and nearly one quarter of the cases are found in the head and neck region. The most common site of origin in the head and neck region is the tongue followed by the orbit. Herein, we present an unusual case of alveolar soft part sarcoma of the tongue in an 18-year-old woman. The clinical, diagnostic, and therapeutic features of this quite rare entity were discussed.