Possible Ototoxic Effects of Topical Rifamycin Application: An Electrophysiological and Ultrastructural Study.

OBJECTIVE: This study aimed to investigate possible ototoxicity associated with topical rifamycin application via electrophysiological tests and ultrastructural examinations. METHODS: Electrophysiological assessment was performed with tympanometry, auditory brainstem response (ABR), and distortion product otoacoustic emission (DPOAE) measurements. This study was conducted on 40 ears of 20 guinea pigs that were detected to have normal hearing thresholds. The animals were randomly assigned to three groups: Group 1 (n=12) received 0.1 mL rifamycin, Group 2 (n=8) received 0.1 ml gentamycin, and Group 3 (n=20) received 0.1 mL physiological saline. The antibiotics and saline solutions were administered via intratympanic injections. After five injections every other day, electrophysiological tests were performed again on the 15th day. After electrophysiological measurements, the temporal bones of all guinea pigs were prepared for ultrastructural examinations and the cochlear surface morphology was examined by scanning electron microscopy (SEM). RESULTS: The animals in group 3 did not show a statistically significant change in their DPOAE signal/noise ratio (SNR) or ABR thresholds (p>0.05). In groups 1 and 2, the reduction in the DPOAE SNR and the increase in the ABR threshold were statistically significant (p<0.05). Regarding SEM examination results, the animals in groups 1 and 2 showed statistically significant outer hair cell damage and cochlear degeneration due to the ototoxic effect of the drugs (p<0.05), whereas the animals in group 3 showed no significant damage (p>0.05). CONCLUSION: The results indicate that rifamycin application to the middle ears of guinea pigs has mild ototoxic effects on their inner ears.

[The evaluation of the outcomes of nasal obstruction surgery by acoustic rhinometry measurements and effects of nasal obstruction on daytime sleepiness]. / Nazal obstrüksiyon cerrahi sonuçlarinin akustik rinometri ölçümleri ile degerlendirilmesi ve burun tikanikliginin gündüz uykululuk hali üzerine etkisi.

OBJECTIVES: In this study, we aimed to investigate the correlation between nasal obstruction findings of the patients who underwent nasal surgery, as assessed by analog scales for the patients and physician and acoustic rhinometry measurements and to establish the effect of nasal obstruction on daytime sleepiness. PATIENTS AND METHODS: Between August 2007 and September 2008, 55 patients (40 males, 15 females; mean age 30 years; range 15 to 56 years) who admitted with the complaint of nasal obstruction and underwent nasal surgery were included. Pre- and postoperative acoustic rhinometry measurements for both nasal cavities were performed. Nasal obstruction was graded by the analog scales for patients and physicians. Epworth Sleepiness Scale (ESS) was used for the evaluation of nasal obstruction on daytime sleepiness. RESULTS: In the preoperative period, a statistically significant correlation between the analog scales for the patients and physicians, and acoustic rhinometry values was found, while no statistically significant correlation was available in the postoperative period. A statistically significant correlation was also observed between pre- and postoperative analog scales for the patients and physicians. There was a statistically significant difference between the pre- and postoperative ESS scores. CONCLUSION: Acoustic rhinometry is a reliable method which provides objective data regarding the effects and outcomes of surgery. The analog scales are also useful to establish the degree of nasal obstruction. Nasal obstruction has an effect on increased complaints of daytime sleepiness.

[Effect of the levels of vascular endothelial growth factor-A and C on the prognosis of patients with laryngeal carcinoma]. / Larenks kanserli hastalarda vasküler endotelyal büyüme faktörü A ve C düzeylerinin prognoza etkisi.

OBJECTIVES: In this study, we determined the prognostic importance of vascular endothelial growth factor (VEGF)-A and C values and their relationship with tumor stages and neck lymp node involvement and also, the relationship between microvessel density and tumor stage in the pathologic specimens. PATIENTS AND METHODS: Thirty-three male patients (mean age 57.8±7.2 years; range 49 to 69 years) who underwent surgical treatment for laryngeal squamous cell carcinoma and a control group of 13 healthy male subjects (mean age 54.2±6.1 years; range 41 to 62 years) were included in the study. Patients were divided into two groups: the early-stage group consisting of patients with T1 and T2 stage tumors and the advanced stage group including patients with T3 and T4 stage tumors. Patients are evaluated in terms of plasma VEGF-A and C levels before and six months after the surgery. In the pathologic specimens, CD 31 was used for immunohistochemical staining. For each patient the number of microvessels per millimeter square (microvessel density) was determined. RESULTS: The preoperative plasma VEBF-A levels of the patients with early-stage tumors were significantly lower compared to those of the control group, while there was no significant difference between the preoperative levels of the patients with advanced stage tumors and the levels of the control group. There was no significant difference between the preoperative and postoperative 6th month VEGF-A levels of the patients both in the early-stage and the advanced stage groups. The preoperative plasma VEGF-C values of the patients with lymph node involvement were significantly lower than those of the patients with early-stage tumors. There was no significant difference between the VEGF-C levels in pre- and postoperatively at six months after the operation of patients with lymph node involvement. There was no significant difference between the preoperative VEGF-C levels of the patients with lymph node involvement and those without lymph node involvement. No significant difference was found in microvessel density between the cases with early and advanced stage tumors. CONCLUSION: It was seen that the plasma VEGF-A value did not increase in patients with laryngeal cancer and rather it is low in patients with early-stage disease. No relationship was found between the plasma VEGF-C values and cervical lymph node involvement.

Influence of anaesthetic agents on transient evoked otoacoustic emissions and stapedius reflex thresholds.

This aim of this study was to determine the effect of anaesthetic agents on stapedius reflex (SR) thresholds and transient evoked otoacoustic emissions (TEOAE). Fifty patients who were scheduled for operation and who had normal hearing were included in the study. All were given midazolam for premedication and propofol for induction. Anaesthesia was maintained in five different ways in each group of 10 patients. Groups I-IV received inhalational anaesthesia: group I received 70 per cent N2O plus 30 per cent O2, group II sevoflurane, group III desflurane and group IV halothane. Group V received total intravenous anaesthesia with propofol plus sufentanil. The SR and TEOAE of the patients were measured four times: on the day before surgery (first measurement), after premedication (second measurement), after induction of anaesthesia (third measurement) and during maintenance of anaesthesia (fourth measurement). Midazolam significantly increased ipsilateral and contralateral SR thresholds and decreased TEOAE wave reproducibility. Propofol significantly increased only the SR thresholds. The other anaesthetic agents significantly increased only the contralateral reflex thresholds. Of these, the highest increase was seen after sevoflurane and the lowest after halothane. The changes in TEOAE wave reproducibility due to anaesthetic agents used for maintenance were not significant. We concluded that midazolam premedication may affect audiological evaluation with SR and TEOAE tests, and sevoflurane should not be used when it is necessary to measure SR under general anaesthesia.

[The predictive value of assessing mastoid pneumatization in pre-dive examinations]. / Dalici muayenesinde mastoid pnömatizasyon derecesinin barotravmayi öngörmedeki degeri.

OBJECTIVES: We investigated the value of assessing the degree of mastoid pneumatization in predicting middle ear barotrauma -the most common problem in sport SCUBA divers- in comparison with that of the conventional pre-dive examination method, the Valsalva maneuver. MATERIALS AND METHODS: Thirty-four volunteer sport SCUBA divers having normal pre-dive examination findings were included. The Valsalva test was performed in all the divers. Mastoid pneumatization for each ear was calculated on a Schuller's view radiography. Pneumatization of = or <30 cm2 was accepted as poor (prone to barotrauma) and >30 cm2 was accepted as good (not prone to barotrauma). During the observation period, the divers were monitored with regard to barotrauma symptoms and signs. RESULTS: The degree of mastoid pneumatization was = or <30 cm2 in 26 ears (38%) of 16 divers (47%). The Valsalva test was negative in eight ears (12%) of six divers (18%). During a total of 1001 dives, symptomatic middle ear barotrauma occurred in 28 dives (2.8%), i.e. in 21 ears (31%) of 16 divers (47%). Of these, the degree of mastoid pneumatization predicted barotrauma in 11 (69%) divers, whereas the Valsalva test was negative in only three (19%) (p<0.05), with sensitivity, specificity, positive and negative predictive values, and efficiency being 69% and 19%, 72% and 83%, 69% and 50%, 72% and 54%, and 71% and 53%, respectively. CONCLUSION: The value of assessing mastoid pneumatization in predicting middle ear barotrauma in sport SCUBA divers is higher than that of the Valsalva test.

Bilateral choanal atresia in premature monozygotic twins.

Bilateral congenital choanal atresia is a relatively rare anomaly of the upper airway, which may cause life-threatening respiratory emergency and require rapid diagnosis and treatment. This condition usually occurs sporadically, but has also been rarely described in siblings. We present monozygotic premature twin infants with identical findings of bilateral choanal atresia and no other associated anomalies. To our knowledge, this is the first report of such an occurrence.

Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results.

The combined Heermann and Tos (CHAT) technique is the combination of Heermann's 'cartilage palisade tympanoplasty' and Tos's 'modified combined approach tympanoplasty = modified intact canal wall mastoidectomy'. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14-57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7-30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.

Supracricoid partial laryngectomy with cricohyoidopexy and cricohyoidoepiglottopexy: functional and oncological results.

Sixty-eight patients who presented with glottic and glottosupraglottic squamous cell carcinoma and who were managed in this department with supracricoid partial laryngectomy (SCPL) with either cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP), were retrospectively reviewed. The authors analysed the functional and oncological results of the patients. The median follow-up period was 62 months. The average times until decannulation and nasogastric feeding tube removal were 27.7 and 26.4 days, respectively. All patients were successfully decannulated. All patients were able to swallow, but one patient was unable to swallow and had recurrent aspiration. Better functional results were achieved in patients managed with CHEP procedure than the patients managed with CHP procedure. The five-year absolute and cause-specific actuarial survival rates (Kaplan-Meier method) were 78.6 per cent and 93.9 per cent, respectively. The five-year actuarial local control and nodal control rates were 89.5 per cent and 90.4 per cent, respectively. Local recurrence was statistically more likely in patients with positive resection margins (p <0.006). Overall, local control and laryngeal preservation were achieved in 95.6 per cent and 89.7 per cent, respectively. Supracricoid partial laryngectomy procedures (CHEP and CHP) are possible alternatives to total laryngectomy in the treatment of selected advanced glottic and glottosupraglottic carcinomas.

Effect of middle ear effusion on distortion product otoacoustic emission.

OBJECTIVES: It is well documented that children, particularly between the ages of about 2 and 6 years, exhibit a high prevalence and incidence of otitis media. Distortion product otoacoustic emissions (DPOAEs) offer great potential for clinical testing of cochlear function in children. The aim of the present study was to determine the influence of middle ear effusion and physical properties of the effusion on the recording of DPOAE. METHODS: Nineteen children (38 ears) undergoing myringotomy and/or tympanostomy tube insertion for secretory otitis media were studied. Pre-operative and post-operative first day DPOAE signal to noise ratios were compared. The results were analyzed by paired samples test and ANOVA statistical methods. RESULTS: We were found significant differences between pre-operative and post-operative first day DPOAE signal to noise at 1, 1.5, 2 and 4kHz. In addition, comparison of the pre-operative DPOAE signal to noise ratio and per-operative middle ear findings are shown significant differences between glue (thick mucous) and the other three groups (mucous, serous and no-effusion groups) at 2 and 4kHz, and between glue and no effusion group at 8kHz. Also post-operative DPOAE signal to noise ratio in relation to per-operative middle ear findings were significantly different at 2, 4 and 8kHz. The most increase of emissions at the post-operative first day was seen in ears with glue effusion at 1 and 2kHz. CONCLUSIONS: Otitis media with effusion can be monitored by DPOAE measurement pre-operatively and post-operatively. In the pre-operative evaluation, glue effusion may cause a reduction in the emissions at 2, 4 and 8kHz more than the other kind effusions.

[Assessment of quality of life in patients with laryngeal cancer after surgical treatment]. / Larenks kanserli hastalarin cerrahi tedavi sonrasi yasam kalitesinin degerlendirilmesi.

OBJECTIVES: To evaluate quality of life of patients undergoing surgical treatment for larynx cancer and to compare quality of life between patients with total laryngectomy and partial laryngectomy. PATIENTS AND METHODS: Thirty-two questions were asked to patients who underwent total laryngectomy (22 subjects) or partial laryngectomy (24 subjects). These questions were based on the European Organization for Research on Treatment of Cancer questionnaires Quality of Life--C30 (EORTC-QoL-C30) and adapted to our nation. Patients with total laryngectomy and partial laryngectomy were compared according to the answers. RESULTS: We found significant statistical differences between total and partial laryngectomy patients in 12 questions. When functional disorders were evaluated, the most significant was one associated with communication. However, pain, smell disorders and increased secretion were associated with morbidity that resulted from the type of surgery. It was observed that patients with total laryngectomy were particularly affected psychologically and economically. CONCLUSION: Patients subjected to total laryngectomy experience serious physical and psycho-social disadvantages that arise from the treatment. In order to establish these negative effects and to minimize them, tools of assessment of quality of life should be developed. This assessment should be appropriate for our nation, providing information and psychological support for individuals and their families.

Alternobaric vertigo in sport SCUBA divers and the risk factors.

We investigated the eustachian tube function and the incidence of alternobaric vertigo (AV) in 29 sport self-contained underwater breathing apparatus (SCUBA) divers with, or without, some possible risk factors for AV. The divers had normal audiological and otoscopic findings at the pre-dive examination. We used the nine-step inflation/deflation tympanometric test and Toynbee test for evaluation of eustachian tube function, and the Valsalva manoeuvre for patency. Information on divers, their history, and their otolaryngologic examination were obtained in the pre-dive examination. Divers performed 1086 dives (mean 37, range: 3-100) during the observation period. Four divers (14 per cent) experienced AV during five dives (0.46 per cent), (one diver experienced AV two times). It was found that having an otitis media history or eustachian tube dysfunction determined with the nine-step inflation/deflation tympanometric test before diving, or difficulty in clearing ears during diving could be important risk factors for AV in sport SCUBA divers (p <.05). Divers with such findings seem to be more prone to AV and should pay rigorous attention to the precautions for prevention of AV.

Effect of topically applied povidone-iodine on transient evoked otoacoustic emissions in guinea pigs.

The possible cochlear toxicity of topically applied povidone-iodine solution was investigated in guinea pigs by measuring transiently evoked otoacoustic emissions (TEOAEs). Seven adult pigmented guinea pigs (14 ears) with a normal acoustic pinna reflex were used. After the baseline TEOAE measurements, 0.1 mL of povidone-iodine solution was applied transtympanically into the middle ear in the study group. Saline solution and gentamicin were used as negative and positive control, respectively. TEOAE measurements were repeated on the 10th day, and four weeks after the first application. Tympanometric measurements were also carried out for both ears of all animals at the end of the study. Responses in all ears, which had povidone-iodine applied to them, disappeared in a way similar to those recorded in gentamicin-treated ears. Tympanometric measurements at the end of the study showed 'type A' tympanograms in all ears of all animals. The present study showed that povidone-iodine could have a cochleotoxic effect in guinea pigs. A study in humans with TEOAE before and after middle-ear surgery, where povidone-iodine can reach into the middle-ear cavity, may be useful for evaluating this result for clinical practice.

A case of epithelial-myoepithelial carcinoma of the parotid gland.

Epithelial-myoepithelial carcinomas comprise approximately 1% of all salivary gland neoplasms. Most tumors arise in the major salivary glands, especially in the parotid gland. We present a case of epithelial-myoepithelial carcinoma of the parotid gland in a 65-year-old male patient. Magnetic resonance imaging showed an irregular and heterogeneous mass in the left parotid gland. Superficial parotidectomy was performed. There was no evidence of recurrence during a 21-month follow-up.

Relationship between mastoid pneumatization and middle ear barotrauma in divers.

OBJECTIVES/HYPOTHESIS: Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (self-contained underwater breathing apparatus) divers. STUDY DESIGN: Prospective, blinded. MATERIAL AND METHODS: Twenty-four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x-ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization. RESULTS: ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2. CONCLUSION: Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.