The Effect of Auricular Graft Donor Site on Morbidity and Cosmetic Appearance in Cartilage Tympanoplasties.

OBJECTIVES: The aim of the present study was to compare the postoperative morbidity and cosmetic results between the use of the scapha and the use of the tragus as the auricular cartilage graft donor site in patients who had undergone cartilage tympanoplasty. The fascia graft was used as the control. MATERIALS AND METHODS: The patient's visual symmetry, cosmetic satisfaction, and anthropometric measurements were studied to objectively evaluate the cosmetic condition. The formation of skin scar changes, pigmentation changes, and sensory changes as clinical criteria were compared. RESULTS: A total of 234 patients and their 257 operated ears were included in the study. Forty prospectively operated ears with preoperative findings were also included. All patients (100%) felt that their results were good, as indicated by the visual analog scale, and the anthropometric ear measurements used to reinforce the data showed no significant differences between the groups. A significant difference with respect to clinical sensory changes was found between the groups only in patients undergoing unilateral surgery via the retro auricular approach (p<0.05). There was no difference between the scapha and tragus groups with respect to scar formation or skin pigmentation change. CONCLUSION: Neither scapha nor tragus use for graft retrieval led to dissatisfaction or cosmetic problems in the postoperative period. Sensory changes in the skin on clinical evaluation were less common in patients in whom the scapha donor site was preferred than in cases in which the tragus was used.

The Effects of Experimental Intratympanic Steroid Administration on Organ of Corti Type 1 Spiral Ganglion.

Introduction It is unclear how effective is the intratympanic (IT) steroid treatment on organ of Corti type 1 spiral ganglion, its optimal dosage and frequency of administration. The effect of dexamethasone on cochlear functions in individuals with a normal hearing ability is also unknown. Objective The aim of this study was to evaluate, at the electrophysiological and ultrastructural levels, the effect of IT dexamethasone administration in guinea pigs with normal hearing on organ of Corti type 1 spiral ganglion. Methods A total of 20 guinea pigs ( n = 40 ears) whose hearing was detected to be normal by electrophysiological tests were included in the study and randomly divided into 6 groups. Four groups were considered study groups, while 2 groups were considered control groups. Dexamethasone was administered intratympanically in doses of 2 mg/mL and 4 mg/mL in the guinea pigs in the study groups. The animals in the control groups received physiological saline in equal doses as the study groups. All interventions were performed under general anesthesia, and the electrophysiological tests were repeated following the IT injections. Results No statistically significant differences were found among the groups when the IT injections were evaluated in terms of the electrophysiological measurements ( p > 0.05). The ultrastructural evaluation showed a cellular mitochondrial increase in the spiral ganglions of the cochlea in the groups in which dexamethasone was administered in a dose of 4 mg/mL. Conclusion According to the findings of this study, it can be suggested that the IT injection of dexamethasone is safe, and when applied in a dose of 4 mg/mL, it increases metabolic activity at the cellular level.

Effect of Topical Dexamethasone for Preventing Experimentally Induced Myringosclerosis.

OBJECTIVE: We aimed to examine the effect of topical dexamethasone by otomicroscopic and histologic examinations for preventing myringosclerosis induced by myringotomy in rat tympanic membranes. METHODS: Twenty-one Sprague Dawley rats (42 ears) were randomly divided into the following three groups after otomicroscopic examinations: experimental surgical group (5 rats), control group (8 rats), and study group (8 rats). The rats of all the groups underwent myringotomy in both tympanic membranes. Other than myringotomy, no additional procedure was performed for the rats in the experimental surgical group. In the control group, 0.9% NaCl was applied to the ears, whereas in the study groups, topical dexamethasone was applied to the ears. These applications in the control and study groups were repeated for nine days. On the 10th day of the study, the rat ears of all groups underwent otomicroscopic and histologic examinations. The prevalence and process of myringosclerosis were evaluated by otomicroscopic examination, whereas inflammation, membrane thickness, and myringosclerosis intensity were evaluated by histologic examination. RESULTS: The growth of myringosclerosis with otomicroscopic examination was lesser in the study group in which topical dexamethasone was applied than the control and the experimental surgical groups. Moreover, it was observed that myringosclerosis effected fewer quadrants in the study group.Histologic examinations revealed that inflammation was significantly lesser in the study group than in the experimental surgical and control groups. The average membrane thickness values were significantly lesser in the study group than in the experimental surgical group. With respect to myringosclerosis growth, no statistically significant difference was observed among all groups, whereas with respect to myringosclerosis intensity, the rat ears in the study group were less severely affected. CONCLUSION: Thus, our study results suggest that applying topical dexamethasone after myringotomy has positive effects on limiting the intensity and prevalence of myringosclerosis.

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.

Dermoid cyst of the parotid gland: first pediatric case.

A dermoid cyst is the result of inclusion of epithelial cells along the lines of embryonic closure. Dermoid cysts of the head neck are uncommon and account for only 7% of all such cysts. They are most often reported as arising in the floor of the mouth. Dermoid cyst is rarely seen in the parotid gland. To our knowledge, there have been only six previous case reports in the English literature. Dermoid cyst of the parotid gland in pediatric patient has not been previously reported in the literature. This is the first case report concerning a dermoid cyst in a pediatric patient.

Primary nasopharyngeal tuberculosis.

Primary nasopharyneal tuberculosis is a rare disease which is commonly present with cervical lymphadenopathy. It is hard to differenciate the diagnosis of tuberculosis from nasopharyngeal carcinoma. Histologic and bacteriologic evaluation is required for diagnosis. A male patient at the age of nineteen applied to our clinic with the complaints of a mass in the neck, congestion in the nose, night sweating and weight loss. Clinical presentation of the patient was similar to that of a malignant tumor of the nasopharynx. Histologic and bacteriologic study supported the diagnosis of tuberculosis. After anti-tuberculosis therapy, the complaints of the patient regressed. We present a nasopharyngeal tuberculosis case in this study.

[Papillary carcinoma arising from a thyroglossal duct cyst]. / Tiroglossal duktus kistinden kaynaklanan papiller karsinom.

Thyroglossal duct cyst is the most common midline congenital neck anomaly. Carcinoma arising from a thyroglossal duct cyst is a rare entity, the most common histological type being papillary carcinoma. A 23-year-old male patient presented with a painless mass at the level of the hyoid bone in the midline of the neck. It was mobile on swallowing. With an initial diagnosis of thyroglossal duct cyst, the lesion was removed with the Sistrunk procedure. Histopathological examination of the surgical specimen showed papillary carcinoma arising from the thyroglossal duct cyst. Thyroid suppression therapy was initiated postoperatively. The patient has been under follow-up for 30 months with no recurrence.

Evaluation of hearing in children with autism by using TEOAE and ABR.

Assessment of auditory abilities is important in the diagnosis and treatment of children with autism. The aim was to evaluate hearing objectively by using transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR). Tests were performed on 30 children with autism and 15 typically developing children, following otomicroscopy and tympanometry. The children with autism were sedated before the tests. Positive emissions and normal hearing level at ABR were obtained in both ears of all children in the control group and of 25 children with autism. TEOAE and ABR results varied in the remaining five children with autism. The mean III-V interpeak latencies (IPLs) in both ears of children with autism were longer than those in the control group. Hearing loss may be more common in children with autism than in typically developing children.

[Analysis of the psychological symptoms of patients following surgery for laryngeal cancer]. / Larenks kanseri nedeniyle ameliyat olan hastalarin psikolojik semptom dagiliminin incelenmesi.

OBJECTIVES: We evaluated psychological symptoms of patients who underwent partial or total laryngectomy for larynx cancer. PATIENTS AND METHODS: The study included 63 patients who underwent total (n=41) or partial (n=22) laryngectomy. The control group consisted of 20 healthy individuals with similar gender, age, and sociocultural characteristics. During the postoperative follow-up, the psychological symptom distribution of the patients was assessed with the Symptom Check-List-90-Revised (SCL-90-R). RESULTS: The SCL-90-R inventory was administered at a mean of 20.6 months (range 10 to 86 months) postoperatively. Patients with total laryngectomy had significantly higher scores than the controls in the subscales of interpersonal sensitivity, depression, anger-hostility, phobic anxiety, and global symptom index (p<0.05). Partial laryngectomy patients exhibited lower scores than total laryngectomy patients, and higher scores than the control group. The only significant difference between partial laryngectomy patients and the control group was in the subscale of anger-hostility (p<0.05). CONCLUSION: Patients with laryngeal cancer should be given postoperative psychological support to minimize adverse effects of total or partial laryngectomy.

[Assessment of patients with sudden hearing loss by transcranial Doppler ultrasonography]. / Ani isitme kayipli hastalarin transkraniyal Doppler ultrasonografi ile degerlendirilmesi.

OBJECTIVES: We evaluated the utility of transcranial Doppler ultrasonography in determining the vascular pathology in patients with sudden hearing loss. PATIENTS AND METHODS: The study included 13 patients (11 males, 2 females; mean age 46.6+/-17.7 years; range 18 to 66 years) with a diagnosis of sudden hearing loss. Patients having chronic otitis media or other middle ear diseases or a history of surgery in the affected ear were excluded. All the patients were evaluated by pure-tone audiometry, impedance audiometry, transient evoked otoacoustic emissions, auditory brainstem responses, and transcranial Doppler ultrasonography. The results were compared with those of a control group of 19 age- and sex-matched healthy subjects (12 males, 7 females; mean age 46.8+/-6.9 years; range 33 to 58 years) who did not have any ear disease or a history of ototoxic drug intake or working in a noisy environment, and no pathology on otoscopic and audiometric examinations. RESULTS: Compared to the normal ear, the mean blood flow and systolic flow velocities of the vertebral artery were significantly decreased, and the mean pulsatile index was significantly increased on the affected side. The mean flow velocity of the basilar artery in the patient group was lower than that found in the control group. CONCLUSION: Transcranial Doppler ultrasonography can be used for the evaluation of vascular involvement of the vertebral and basilar arteries in patients with sudden sensorineural hearing loss.

[The protective effect of oral magnesium supplement on noise-induced hearing loss]. / Gürültüye bagli isitme kaybinda magnezyumun koruyucu etkisi.

OBJECTIVES: We investigated the beneficial effect of magnesium in the prevention of noise-induced cochlear damage in guinea pigs by transient evoked otoacoustic emissions (TEOAE). STUDY DESIGN: Thirty-nine guinea pigs with normal auropalpebral reflex were randomly divided into control (n=20) and study (n=19) groups. All the animals were subjected to wide-band noise standardized at a mean of 98+/-2 dB for 16 hours a day for 10 days in a sound isolated cabin. The study animals received 39 mmol/l MgCl2 throughout the study period starting from 15 days before noise exposure. Otomicroscopic examination, auditory brain stem response (ABR) and TEOAE measurements were performed before and after noise exposure. Tympanometric measurements were performed to eliminate possible middle ear pathologies. RESULTS: Although the mean TEOAE response and reproducibility values showed significant decreases after noise application in the control group (p<0.001), they were not affected significantly in magnesium-treated animals. Post-exposure mean TEOAE response and reproducibility values significantly differed between the two groups (p<0.001). Noise-induced elevations in ABR thresholds were significant in both groups (p<0.001); however, it was noted that hearing levels were better preserved in the study group. CONCLUSION: Our data suggest that oral magnesium intake may be beneficial in the prevention of cochlear damage in noise-induced hearing loss.

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.

Otoacoustic emissions in young adults with a history of otitis media.

The aim of this study was to investigate otoacoustic emissions in young adults who had a history of otitis media (OM) in childhood and to assess whether a history of OM had an irreversible effect on hearing. We studied 116 cases between 15 and 25 years of age, divided into three groups. Each subject underwent a single examination comprising otoscopy, pure-tone audiometry (PTA), tympanometry, and transient evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) testing. Subjects in the first and second groups had normal audiometric hearing thresholds and type A tympanograms. The only difference between the first and second group was the presence or absence of a history of OM. The third group consisted of patients diagnosed as having active OM; these patients had poorer hearing thresholds and type B or C tympanograms. After statistical analysis of TEOAE and DPOAE results (one-way analysis of variance test), significant differences were noted between groups. Otoacoustic emission levels were, unsurprisingly, lowest in the third group, as expected. However, the most striking result in the study was that significantly fewer otoacoustic emissions were detected in subjects with a history of OM than in subjects without a history of OM. These findings suggest that OM in childhood may cause minor but irreversible damage to the middle ear or cochlea. Otoacoustic emissions testing can be used to detect this sub-clinical damage.

[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.

[Evaluation of the protective effect of magnesium on amikacin ototoxicity by electrophysiologic tests in guinea pigs]. / Amikasin ototoksisitesinde magnezyumun koruyucu etkisinin kobaylarda elektrofizyolojik testlerle degerlendirilmesi.

OBJECTIVES: This experimental study was performed to evaluate the protective effect of magnesium on amikacin ototoxicity. STUDY DESIGN: Twenty-seven guinea pigs (54 ears) with normal auropalpebral reflexes and otomicroscopic examination, auditory brain stem responses (ABR), and transient evoked otoacoustic emissions (TEOAE) were randomly divided into four groups to receive amikacin once 15 mg/kg daily (group 1 and 3) and twice 7.5 mg/kg daily (group 2 and 4) for seven days. Groups 3 and 4 were administered oral MgCl an hour after amikacin use at a dose of 39 mmol/l and 19.5 mmol/l, respectively, for seven days. Otomicroscopic examination, ABR and TEOAE measurements were repeated on the third, fifth, and seventh days. RESULTS: Compared to group 1, decreases in TEOAE amplitudes and reproducibility and increases in ABR thresholds were significant in group 2 (p<0.05). However, in groups 3 and 4, TEOAE amplitudes remained unchanged, or even increased and the reproducibility of TEOAE responses and ABR thresholds showed no significant changes (p>0.05). CONCLUSION: Our data show that oral magnesium may play a protective role on amikacin ototoxicity.

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.

Thyroid gland tuberculosis with endolaryngeal extension: a case with laryngotracheal dyspnoea.

Tuberculosis affecting the thyroid gland is a rare condition. We present the case of a 30-year-old man with thyroid tuberculosis whose presenting complaints were dyspnoea and hoarseness. There was a cystic mass in the posterosuperior right thyroid lobe extending into the paraglottic space. There was also recurrent laryngeal nerve involvement. We performed surgery and administered post-operative antituberculous treatment.