Voice abnormalities and their relation with motor dysfunction in Parkinson's disease.

OBJECTIVE: To evaluate changes in perceptual and several acoustic parameters of voice in patients with Parkinson's disease (PD) and to find out any relation with these parameters and motor components of Unified Parkinson's Disease Rating Scale (UPDRS) in this patient group. MATERIALS AND METHODS: Twenty patients with PD (12 male and 8 female) were given objective and subjective voice tests and results were compared with those of 20 age- and sex-matched controls. Patient's perceptual voice analysis was assessed using GRBAS scale including Grade of Dysphonia, Roughness, Breathiness, Asthenia and Strain items. Measurements for objective voice analysis, acoustic assessment tests including frequency perturbation [jitter (jitt)%], intensity perturbation [shimmer (shim)%], noise to harmonic ratio (NHR), fundamental frequency (F0), variability of fundamental frequency (vF0), diadochokinetic rate (DDK) and maximum phonation time (MPT) were used. An assessment of disability caused by voice disorders was scored according to the Voice Handicap Index (VHI) by the patient. All subjects also underwent videolaryngostroboscopic (VLS) examination. Motor components of UPDRS and acoustic parameters of voice were investigated for any correlations. RESULTS: Compared with controls, roughness (P = 0.15), breathiness (P = 0.004) and asthenia (P = 0.031) values of males and breathiness (P = 0.043) and asthenia (P = 0.023) values of females were higher in patients with PD. Mean VHI scores of patients with PD were higher for both male and female patients (P = 0.0001 for male, P = 0.002 for female). The mean values for MPT (P = 0.02) and DDK (P = 0.025) were shorter in patients with PD. Jitt%, shim% and mean F0 values were similar among the two groups. But mean vF0 values were significantly higher in male patients with PD (P = 0.05). On VLS examination, non-closure glottic pattern was found to be more frequent in the PD group. CONCLUSION: Although it is well known that pathophysiological changes in PD affect the voice, the present study found only few significant correlations between motor component of UPDRS and voice parameters.

Clinical importance of supratubal recess in cholesteatoma surgery.

OBJECTIVE: To determine the importance of supratubal recess in cholesteatoma surgery by presenting the clinical presentation, imaging findings, and surgical treatment methods of 66 patients with cholesteatoma. We propose that the management of supratubal recess allows the opportunity for total removal of the cholesteatoma with the prevention of recurrence. STUDY DESIGN: Retrospective review of surgical cases. SETTING: Tertiary referral center. INTERVENTIONS: Diagnostic and therapeutic procedures were performed. PATIENTS AND METHODS: We present a series of patients with involvement of supratubal recess by reviewing the operative charts of 347 patients surgically treated for aural cholesteatoma between 1990 and 1999. RESULTS: We detected the involvement of supratubal recess in 19% (n = 66) of our operations for aural cholesteatoma removal. CONCLUSION: The intent of this study is to improve the chance for a successful outcome by decreasing the rate of recurrence. The surgical approach to supratubal recess in cholesteatoma operations is emphasized with our series.

The effect of endoscopic sinus surgery on mucociliary activity and healing of maxillary sinus mucosa.

The aim of this study was to determine histologic findings in the maxilaarysinus mucosa by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), and ciliary activity within the nasal cavity by measuring the speed of mucociliary transport and after endoscopic sinus surgery (ESS). Thirty patients were enrolled. Thirty-eight antral mucosae of 24 24 patients were investigated according to ultrastructural changes and 6 patients were accepted as controls. At the 12th week, 12 antral nasal mucosae specimens of 8 patients were evaluated. All the specimens were taken from the medial rear wall of the antrum. The specimens were observed under a SEM and TEM. The mucociliary activity was measured within the nasal cavity by a saccharin test in all patients before the operation and after 12 weeks. Twenty people served as controls. In the specimens of the preoperative mucosa, the ciliated epithelium was heavily deciliated, interdigitation of the cell was loosened. In the samples taken 12 weeks after the operation, the ciliated cells were irregularly seen, the number of goblet cells was about the same as in the preoperative group and in the control, the number of the gland openings was higher than in the preoperative group and in the control. Also the interdigitation of the cells was enhanced. The histological and morphological features of the mucosa had improved. The period of the preoperative saccharin test was 12.15 minutes, whereas the period of the postoperative test was 9.08 minutes. The improvement was significant but both results were also significantly longer compared to the controls. These observations suggest that the histological, morphological and mucocilliary activity of the mucosa have not yet improved completely, it takes more than 12 weeks to recover, and the patients should be closely monitored in the postoperative months.

Effects of topical otic preparations on hearing in chronic otitis media.

Most of the topical otic preparations have been shown to cause ototoxicity. In this study ciprofloxacin hydrochloride, a relatively new topical agent, and gentamicin sulfate were studied in two groups of 20 patients with chronic otitis media. Patients were randomly selected to receive either ciprofloxacin (200 microg/ml) or gentamicin sulfate (5 mg/ml) locally, five drops three times a day for 10 days. Clinical response was seen in 20 of 20 patients in the ciprofloxacin group compared with 6 of 20 patients in the gentamicin group. Audiometric evaluation revealed no significant ototoxic effect in either group. In fact, hearing thresholds were slightly better than pretreatment levels in both groups.

Treatment of chronic ear disease. Topical ciprofloxacin vs topical gentamicin.

OBJECTIVE: To determine and compare the therapeutic efficiency of ciprofloxacin hydrochloride and gentamicin sulfate in the treatment of chronic ear disease. DESIGN: Prospective randomized study. SETTING: Academic tertiary medical center. PATIENTS: Consecutive referred sample of 44 patients with chronic suppurative otitis media randomized into two groups. INTERVENTIONS: Ciprofloxacin hydrochloride (200 mg/mL) was administered to the first group (composed of 24 patients), while the second group (composed of 20 patients) received gentamicin sulfate (5 mg/mL) locally, five drops three times a day for 10 days. RESULTS: In the ciprofloxacin group, 21 (88%) of the 24 patients with suppurative chronic otitis media were cured. On the other hand, only six (30%) of the patients in the gentamicin group were cured. The rest of the patients showed no clinical or bacteriological improvement. CONCLUSIONS: To our knowledge, this is the first study to compare the efficiency of two topical otic preparations in the treatment of chronic ear disease. The results show that topical ciprofloxacin preparation is more efficacious and efficient than topical gentamicin for the treatment of chronic otitis media in the acute stage.

The regeneration of the middle ear mucosa of the rat.

The purpose of the study was to investigate the regeneration of middle ear mucosa following surgical removal and to observe the effects of Silastic sheetings on regeneration. Two weeks after the operation the middle ear cavity was covered by moderately differentiated epithelium in the animals which had only the mucosa removed. In animals with inserted Silastic sheeting, infection slowed down the regeneration process. During the 2 months of postoperative observation, the surface of the cavity appeared to be rough, and there was intensive fibrin deposition over the mucosa. It is concluded that normal middle ear mucosa regenerates rapidly after surgical removal. On the other hand and in contrast to the purpose of its usage, Silastic sheeting slows down the process and causes fibrosis.

Squamous epithelium in the middle ear and sinus.

This study has been performed between December 1990-March 1991 in the Microsurgery laboratory of the Marmara University Hospital. Twelve healthy albino guinea pigs were used as a study group while the control group consists of three animals. The potentials for cholesteatoma formation of the squamous epithelium, namely the squamous epithelium of the posterior superior part of the external ear canal skin and normal skin, were investigated. Among 24 subjects who were implanted by canal skin, cholesteatoma was formed in 21 of them. Likewise, 19 of 24 animals implanted by normal skin came out with cholesteatoma formation. Between these two types of epithelium, there is no statistical difference in cholesteatoma formation (p > 0.5).

Hemangiopericytoma as the cause of Collet-Sicard syndrome.

Collet-Sicard syndrome is one of the jugular foramen syndromes in which the last four cranial nerves are involved whereas the sympathetic plexus is spared. It is very uncommon to find facial paralysis associated to this syndrome and most interestingly, a hemangiopericytoma at this location to cause all these paralyses. We have not been able to find a similar case in the literature, and thus present our case.

Stapedectomy as an outpatient procedure.

Many ENT surgeons are accustomed to perform stapedectomy in a hospital setting. We present our results with 19 patients on whom stapedectomies were performed in an outpatient setting. In respect of hearing gain and complications, our results are not significantly different from the results of those series of stapedectomies performed in hospital. Thus, we believe that stapedectomy can be performed as an outpatient procedure.