Correlations of Clinical and Audio-Vestibulometric Findings with Coexisting Anxiety and Depression in Ménière's Disease Patients.

INTRODUCTION: Ménière's disease (MD) is an inner ear disorder, characterized by vertiginous attacks, fluctuating sensorineural hearing loss, tinnitus, and a feeling of ear fullness. Endolymphatic hydrops has been proven as the underlying pathology. Frequently, psychopathologies accompany the disease. The aim of this study was to investigate the correlation of anxiety and depression with demographic, clinical, and audio-vestibular findings in MD patients. METHODS: The study included 40 consecutive unilateral MD patients. Demographic data (age, sex, education, employment, and marital status), clinical variables of drop attacks, the duration, frequency and severity of vertigo attacks, and tinnitus disturbance levels were recorded. Hearing threshold levels were graded between 1 and 4. Vestibulometric variables were taken as the presence of saccades and vestibulo-ocular reflex (VOR) gain deficits in the video head impulse tests (vHIT) and canal paresis in bithermal caloric tests. Becks's depression and anxiety scales were used for psychometric evaluations and graded by 4 and 5 from normal to severe and normal to very severe, respectively. RESULTS: The median age of the patients was 48.94 years, and the numbers of both sexes were almost equal (male/female = 19/21). All patients reported at least one vertigo attacks within the last year. The duration of attacks was most commonly (62.5%) 1-3 h, ranging from <1 h to 17 h. Most attacks were graded as mild (67.5%), and the frequency was 2-3 episodes per year in 22 (55%) patients. The number of attacks within the last year was 1-12. Three patients reported having drop attacks. Hearing loss in the affected ear was moderate/moderately severe in 20 (50%) patients. Thirty-seven (92.5%) patients had complaints of tinnitus. In vHIT, saccades and VOR gain deficits were found in 33 (82.5%) and 11 (27.5%) patients, respectively. Canal paresis was present in 18 (45%) patients. The depression and anxiety rates were 35% and 90%, respectively. Depression scores were correlated with education, marital status, and the presence of saccades. Anxiety was correlated only with tinnitus severity and VOR gain deficits. Depression and anxiety were also correlated. CONCLUSION: Vertigo appears to be more intrusive than the other MD symptoms, and a higher correlation with anxiety than depression was demonstrated in this cohort. However, depression was seen less among married and educated patients, suggesting the role of coping capability, and had more pronounced clinical/vestibulometric correlates. Overall, these results indicated that it is mainly the severity of organic/physiological pathology which determines the degree of depression and anxiety in MD rather than vice versa.

An Analysis of Otology-Neurotology Articles from Turkey Published in Science Citation Indexed Otolaryngology Journals from 2012 through 2016.

OBJECTIVE: The objective of this study was to review the articles on otology-neurotology submitted from Turkey and published in Science Citation Indexed (SCI) and Science Citation Index-Expanded (SCI-E) journals in the period from 2012 through 2016 in terms of characteristics and quantity, and to analyze the variances in these parameters over the defined time period to profile the national scientific endeavor in the field. METHODS: We searched the papers on otology-neurotology and related subjects that were submitted from Turkey and published in the period from 2012 through 2016 in the relevant journals listed in SCI and SCI-E. We noted the impact factors and quartile rankings of the publishing journals, and reviewed, counted and classified the titles, subjects, types and characteristics of the articles that met our criteria. RESULTS: A total of 546 papers from Turkey were published in 25 SCI and SCI-E listed journals (145 and 401, respectively) in the defined period. The impact factors of these 25 journals ranged from 0.392 to 2.951. Of these papers, 393 (71.97%) were experimental or observational clinical studies, case reports, or surveys; 137 (25.10%) were non-clinical, laboratory or animal experiments; and the remaining 16 (2.93%) were reviews or letters to the editor. CONCLUSION: A substantial number of papers on otology-neurotology submitted from Turkey were published in many prestigious SCI-journals, however, we did not find any significant increase in this number in the given period. We also found concentration of articles in certain journals and inclination to a few subjects and would like to underline that the number of basic science and ecological-epidemiological studies within the confines of our review were relatively few.

A Study on Thermal and Nanomechanical Performance of Cellulose Nanomaterials (CNs).

Wood-based cellulose nanomaterials (CNs) (specifically, cellulose nanofibrils (CNFs) and cellulose nanocrystals (CNCs)) are environmentally sourced low-impact materials with remarkable thermal, mechanical, and physical properties. This uniqueness makes them great candidates for creating nanocomposite materials with a wide range of attributes. Investigating the morphological, thermal, and nanomechanical properties of CNs becomes crucial to intelligent development of novel composite materials. An atomic force microscope equipped with a nanoindenter was used to investigate the compression modulus of CNFs and CNCs using two analytical approaches (denoted as Oliver Pharr (OP) and Fused Silica (FS)). The CNC modulus values (ECNC-FS = 21.1 GPa, ECNC-OP = 28.7 GPa) were statistically larger than those obtained from CNFs (ECNF-FS = 12.4 GPa, ECNF-OP = 15.1 GPa). Additionally, the FS analytical approach provided statistically significant lower estimates. Thermal stability of CNFs and CNCs was investigated using thermogravimetric analysis. Significant differences were found between CNF and CNC onset temperatures (OnsetCNC = 228.2 °C, OnsetCNF = 279.9 °C), decomposition temperatures (DTGACNC = 247.9 °C, DTGACNF = 331.4 °C), and residues (ResidueCNC = 34.4%, ResidueCNF = 22.8%). This research enriches the information on thermal stability and nanomechanical performance of cellulose nanomaterials, and provides increased knowledge on understanding the effect of CNs as a matrix or reinforce in composites.

Sensorineural hearing loss after ossicular manipulation and drill-generated acoustic trauma in type I tympanoplasty with and without mastoidectomy: A series of 51 cases.

Recognized causes of high-frequency sensorineural hearing loss (SNHL) after tympanoplasty with and without mastoidectomy include acoustic trauma from manipulation of the ossicles, the noise generated by suctioning and, in the case of mastoidectomy, the noise generated by temporal bone drilling. We conducted a retrospective study to identify the effects of ossicular manipulation and mastoid drilling on high-frequency SNHL. Our study population was made up of 51 patients-20 males and 31 females, aged 10 to 59 years (mean: 28.5). Of this group, 26 patients had undergone a unilateral over-under tympanoplasty only (tympanoplasty group) and 25 had undergone a unilateral tympanoplasty plus additional mastoid surgery (mastoidectomy group). Bone-conduction audiograms were obtained pre- and postoperatively; the latter were obtained within 24 hours after surgery and again at 6 months of follow-up. In the tympanoplasty group, a significant SNHL, primarily at 2 kHz, was seen in 6 patients (23%) at 24 hours, but at 6 months there was no depression of bone-conduction thresholds. In the mastoidectomy group, a significant SNHL, primarily at 2 and 4 kHz, occurred in 12 patients (48%) at 24 hours, and bone-conduction deterioration was still present in 4 patients (16%) 6 months after surgery. The difference between the preoperative audiograms and the 6-month audiograms in both groups was statistically significant (p = 0.034). We conclude that (1) over-under tympanoplasty, which requires significant manipulation of the ossicles, can cause temporary SNHL after surgery, and (2) prolonged exposure to the noise generated by mastoid drilling can result in permanent SNHL.

Chemical Force Spectroscopy Evidence Supporting the Layer-by-Layer Model of Organic Matter Binding to Iron (oxy)Hydroxide Mineral Surfaces.

The adsorption of dissolved organic matter (DOM) to metal (oxy)hydroxide mineral surfaces is a critical step for C sequestration in soils. Although equilibrium studies have described some of the factors controlling this process, the molecular-scale description of the adsorption process has been more limited. Chemical force spectroscopy revealed differing adhesion strengths of DOM extracted from three soils and a reference peat soil material to an iron (oxy)hydroxide mineral surface. The DOM was characterized using ultrahigh-resolution negative ion mode electrospray ionization Fourier Transform ion cyclotron resonance mass spectrometry. The results indicate that carboxyl-rich aromatic and N-containing aliphatic molecules of DOM are correlated with high adhesion forces. Increasing molecular mass was shown to decrease the adhesion force between the mineral surface and the DOM. Kendrick mass defect analysis suggests that mechanisms involving two carboxyl groups result in the most stable bond to the mineral surface. We conceptualize these results using a layer-by-layer "onion" model of organic matter stabilization on soil mineral surfaces.

A Rare Complication of Radiofrequency Tonsil Ablation: Horner Syndrome.

Chronic tonsillitis is a common disease, and several different surgical techniques are used to treat this condition. In recent years, techniques such as radiofrequency ablation and coblation have been commonly used for tonsil surgery. In this report, we present the cases of two pediatric patients who developed ptosis, miosis, and enophthalmos (Horner syndrome) after radiofrequency ablation for tonsil reduction and discuss the technique of radiofrequency ablation of the tonsils. In the early postoperative period, miosis and ptosis were observed on the right side in one patient and on the left side in the other patient. Both patients were treated with 1 mg/kg/day methylprednisolone, which were tapered by halving the dose every 3 days. Miosis and ptosis improved after treatment in both patients. Along with the case presentation, we discuss the effectiveness and complications of radiofrequency ablation of the tonsils. These unusual complications of tonsil ablation may help ENT physicians who do not yet have a preferred surgical technique for tonsillectomy to make an informed decision. Limited data are available about the possible complications of radiofrequency ablation of the tonsils. The present report contributes to the literature on this topic.

Mean platelet volume levels in children with adenoid hypertrophy.

Adenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.

Dissecting firearm injury to the head and neck with non-linear bullet trajectory: a case report.

Firearm injuries to the head and neck have a potential for fatal complications caused by damage to neurovascular structures in the region. We herewith present a case of a missile injury to the face, caused by a bullet from a rifle with high muzzle energy that slackened while penetrating a vehicle before hitting the victim. The bullet advanced through the retrofacial spaces following a non-linear course and was retained within the opposite parapharyngeal region without injuring any vital structure. The resultant damage was a 'low-velocity injury'. However, it is noteworthy that the missile had still retained enough energy to penetrate the tissue and travel in a 'dissecting' fashion. It is likely that the blunting of the missile during vehicle penetration and the compactness of the anatomical structures bordering the head and neck spaces, such as fascia and tendons, forced the projectile to follow a non-linear inter-structural path. This case yet again demonstrates that the magnitude of firearm-related tissue damage may also depend upon the shape of the projectile and confirms that the head and neck spaces have anatomical integrity rather than just being arbitrarily designated topographical areas. It has also been confirmed that non-surgical approach with regular follow-ups is a viable option for uncomplicated head and neck injuries.

Two-stage aural atresia and stenosis surgery with the use of synthetic skin substitute.

CONCLUSION: With this technique, patency rates achieved in congenital external ear canal (EAC) atresia/stenosis and improvement in hearing were evaluated as 'good' and 'satisfactory', respectively. OBJECTIVES: We aimed to test the efficacy of a novel two-stage technique in preventing restenosis following atresioplasty. PATIENTS AND METHODS: Nine patients with congenital EAC atresia/stenosis comprised our cases. We performed 10 atresioplasties using the two-stage technique described below. In the first stage, the ear canal is drilled and its wall is covered with a synthetic skin replacement that induces proliferation of a soft tissue; in the second stage this is lined underneath with split thickness skin graft. Operations were complemented with tympanoplasties in five of the patients. RESULTS: Nine (91%) of 10 operations carried out with the technique were largely successful in terms of patency. The achieved average hearing gain was air conduction/bone conduction (Ac/Bc): 31.33/9.44 dBHL (21.89 in the air-bone gap), while the postoperative air-bone conduction gap was changed to <30 dBHL in eight (88.9%) of the patients.

Klippel-Feil syndrome and associated ear anomalies.

BACKGROUND AND PURPOSE: Klippel-Feil syndrome (KFS) is a congenital segmentation anomaly of the cervical vertebrae that manifests as short neck, low hair line, and limited neck mobility. Various systemic malformations may also accompany the syndrome including wide variety of otopathologies affecting all 3 compartments of the ear (external, middle, and inner ear) as well as internal acoustic canal and vestibular aqueduct. We aimed to investigate these involvements and their clinical correlates in a group of patients with KFS. MATERIALS, METHODS, AND RESULTS: We present 20 KFS cases, of which 12 (% 60) displayed most of the reported ear abnormalities such as microtia, external ear canal stenosis, chronic ear inflammations and their sequels, anomalies of the tympanic cavity and ossicles, inner ear dysplasies, deformed internal acoustic canal, and wide vestibular aqueduct, which are demonstrated using the methods of otoscopy, audiologic testing, and temporal bone computed tomography. CONCLUSIONS: This series represents one of the highest reported rate of ear involvement in KFS. We found no correlation between the identified ear pathologies and the skeletal and extraskeletal malformations. The genetic nature of the syndrome was supported by the existence of affected family members in 4 (20%) of the cases.

Carcinoid tumor of the middle ear: report of a case.

Carcinoid tumor of the middle ear is an extremely rare lesion of the middle ear, and thus its diagnosis is frequently delayed. Some authors found it hard to differentiate middle ear carcinoid from the middle ear adenoma. However, the balance of opinion is currently on the side of considering it as a separate clinical entity. Definitive diagnosis is made by identifying neurosecretory tumor cells using immunohistochemistry and electron microscopy. It usually follows a nonaggressive clinical course, rarely metastases, and infrequently recurs after radical excisions. We present a patient with middle ear carcinoid, who is free of disease 2 years after the resection of the tumor mass with canal wall-down procedure. The relevant literature is also herewith reviewed.

Otologic and leptomeningeal involvements as presenting features in seronegative Wegener granulomatosis.

Wegener granulomatosis is an immune-mediated, systemic vasculitis with unknown etiology that can be seen in almost any anatomical site. Positivity for antineutrophil cytoplasmic antigene, which is a serological marker, and presence of granulomatous vasculitis in histopathologic specimens from the lesions are accepted as diagnostic. A case of Wegener granulomatosis whose presenting symptoms and signs are related to otologic and meningeal involvement of the disease is reported. Apart from atypical presentation, histopathological and serological findings from this patient remained negative throughout the course of the disease, and the diagnosis was made on the basis of clinical and secondary laboratory findings. We herewith discuss this unusual case in the light of relevant literature.

Cystic hygroma colli in adults: a report of two cases, one with atypical location.

We presented two adult cases of cystic hygroma colli (CHC), one with atypical location. The first patient was a 23-year-old male with CHC located in the posterior cervical triangle, its common location in the neck. The latter was a 22-year-old male whose lesion occupied the submandibular region and extended to the skull base. The diagnosis was made by computed tomography, magnetic resonance imaging, and fine-needle aspiration biopsy, and confirmed by postoperative histopathologic examination. The lesions were surgically removed in both patients, and no recurrence was encountered during postoperative 12 and 14 months, respectively.

Rhinolithiasis: clinical, radiological, and mineralogical features.

BACKGROUND: Rhinolithiasis is a rare and under-diagnosed clinical entity whose etiology and pathogenesis is poorly understood. OBJECTIVE: The objective of the study is to review the clinical and radiologic features of rhinolithiasis and mineralogical-chemical composition of the rhinoliths with the aim of shedding light on its etiology and pathogenesis. METHODS: Our subjects consisted of 8 rhinolithiasis cases. Clinical presentations, signs, and symptoms of the patients with radiologic findings are presented, and X-ray diffraction analyses of the stones were carried out to assess their mineralogical composition. RESULTS: Nasal obstruction appeared to be the chief symptom, followed by nasal discharge and facial pain. Neither exogenous nor endogenous nidi were identified in any of the cases. Mineralogical analyses of the rhinoliths revealed Whitlockite [(Ca,Mg)3 (PO4)2] in one and Dahllite [Ca5 (PO4,CO3)3OH] in 7 cases. CONCLUSION: We hypothesized that some substances or organic objects form the nidi of the rhinoliths and are disintegrated over the course of mineral precipitation. This hypothesis was supported by radiologic and microscopic findings.

[Klippel-Feil syndrome and associated congenital abnormalities: evaluation of 23 cases]. / Klippel-Feil sendromu ve eslik eden dogumsal anomaliler: 23 olgunun incelenmesi.

OBJECTIVES: The purpose of this study was to review adult patients with Klippel-Feil syndrome. METHODS: The study included 23 male patients (mean age 20.5 years, range 19 to 27 years) with Klippel-Feil syndrome. Besides orthopedic clinical evaluation, all the patients were assessed by anteroposterior and lateral cervical flexion/extension and thoracolumbar radiographies, abdominal ultrasonography, and were subjected to systemic examinations to detect any urological, cardiological, otorhinolaryngological, neurological, and psychiatric findings. Temporal computed tomography was performed in seven patients, and cervical magnetic resonance imaging in three patients. RESULTS: Scoliosis, fusion of the cervical vertebrae (between 2-5 vertebrae), low hairline and short neck were found in all the cases. Lumbar fusion was detected in one patient. Other findings included renal agenesis (n=1), different types of hearing loss (n=9), cardiac pathologies (n=5), epilepsy (n=1), and marked (n=1) or mild (n=1) mirror movements. CONCLUSION: Patients with Klippel-Feil syndrome should be assessed for associated systemic abnormalities besides cervical fusion.