Ossiculoplasty with intact stapes: analysis of hearing results according to the middle ear risk index.

CONCLUSIONS: In ossiculoplasty with intact stapes, using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses, improvement in hearing was nearly equal. In patients who had mild risk scores, the incus had better gain values compared with patients who had severe scores. OBJECTIVE: We aimed to prove the utility of the middle ear risk index score and its predictive value in hearing outcome. We also evaluated hearing results for different reconstruction materials. PATIENTS AND METHODS: This was a retrospective chart review of 189 patients who had ossiculoplasty with intact stapes using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses. Hearing outcomes and the average improvement in hearing with different reconstruction materials were analysed by using middle ear risk index scores. RESULTS: The average hearing improvements for incus, cortex and partial ossicular reconstruction prostheses were 12.77±14.58 (p<0.001), 12.34±15.98 (p=0.005) and 14.10±13.87 dB (p<0.001), respectively. The postoperative air-bone gap levels were 20.42±14.54 dB in incus, 17.33±16.86 dB in cortex and 17.59±11.66 dB in partial ossicular reconstruction prostheses. When the preoperative middle ear risk index scores and postoperative air-bone gap and gain values were compared, in the incus group, statistically significant associations were demonstrated between scores and hearing outcomes (p=0.009).

Evaluation of osteogenic and chondrogenic activities of prefabricated periallografts.

Reconstruction of cartilage and bone defects has always been a challenging problem for the surgeon. Basic elements that are responsible for the repair process of these tissues are periost and perichondrium. Although several methods for the use of periost and perichondrium are proposed in the literature, the osteogenic and chondrogenic capacities of these tissues were shown to be the most important factor for a successful outcome. Bone and cartilage formation in acellular dermal matrix (ADM) prefabricated with periost and perichondrium was studied in 20 New Zealand rabbits. Morphologic and histologic evaluation and comparison of the newly formed tissues were evaluated. Four rabbits were excluded from the study because of infection, and specimens were obtained at 4, 6, 8, and 12 weeks after the study began from the remaining 16 rabbits. A gradual increase in bone and cartilage tissue formation through the 4th to 12th weeks was documented by reason of perichondrium and periost activation infiltrating into acellular dermal allografts. In view of the data obtained, it was concluded that periost or perichondrium prefabricated over ADM may be an alternative technique of cartilage and bone formation that may provide adequate tissue with elastic and osteo- and chondroconductive properties for the reconstruction of challenging defects.

[Case report: a case of tularemia with delayed diagnosis]. / Olgu sunumu: Geq tani konulan bir tularemi olgusu.

Tularemia is a zoonotic disease caused by Francisella tularensis. In this report, a tularemia case who was living in a non-endemic area, has been presented. A 24 years old female patient with multiple cervical lymphadenitis has been admitted to the outpatient clinic of Ankara Training and Research Hospital, Turkey. Her complaints started two months ago as signs and symptoms of an upper respiratory tract infection. As she had received non-specific treatment (amoxycillin clavulanate; 2x 1g/day) ineffective against F. tularensis, lymph nodes were suppurated. The diagnosis was made serologically, microagglutination test was positive at a titer of 1/160. The antimicrobial therapy (streptomycin; 1x1 gr im, doxycycline; 2x100 mg/day) was prolonged to four weeks, according to the clinical response of suppurated lymph nodes. It can be concluded that, early diagnosis and treatment of tularemia are important to prevent abscess formation, and patients with delayed diagnosis may benefit from prolonged therapy.

Acoustic rhinometry in the objective evaluation of childhood septoplasties.

OBJECTIVE: The aim of this study was to evaluate results of septoplasty during childhood objectively with the help of acoustic rhinometry (AR). METHODS: Twenty-six children aged between 6 and 15 years who had septoplasty for nasal septal deviation during year 2002 were included in this study. Twenty-one patients who had no nasal septal deformities and nasal symptoms were included as control group. The study group was divided into two subgroups: Group 1 with only anterior septal deviation (8 patients) and Group 2 with both anterior and posterior septal deviations (18 patients). Acoustic rhinometry was performed one day preoperatively and 4 months postoperatively. Preoperative and postoperative minimal cross-sectional areas (MCSA), total volumes (TV), MCSA and TVs on pathologic side were compared. Acoustic rhinometry was performed 2 months interval in control group. Patients and parents were asked about the effectiveness of surgery subjectively. RESULTS: There was a statistical significance between preoperative and postoperative MCSAs of Groups 2 and 1+2. There was no statistical significance for Group 1. There was statistical significance between control group and Groups 1, 2, 1+2 in terms of MCSAs, MCSAs on pathologic side and TVs on pathologic side. There was statistical significance in terms of preoperative and postoperative MCSAs, TVs, MCSAs and TVs on pathologic side in patients with subjective well being postoperatively. There was no statistical significance in patients without any subjective postoperative improvement in terms of preoperative and postoperative MCSAs and MCSAs on pathologic side while TVs and TVs on pathologic side were statistically significant. CONCLUSIONS: Surgery is successful in children. But it should be restricted to only the pathologic area and should be conservative. Acoustic rhinometry is an objective method for the evaluation of nasal septal deformities and surgical success. Further studies are needed to see long-term success of septal surgery in children.

Is septoplasty alone adequate for the treatment of chronic rhinosinusitis with septal deviation?

BACKGROUND: The purpose of this study was to reveal the role of septoplasty in curing chronic rhinosinusitis (CRS) in patients with significant septal deviation. METHODS: This prospective study involved 26 patients with CRS and septal deviation. The patients were randomly divided into two groups according to the applied surgical procedures. In the first and second groups, septoplasty and septoplasty plus endoscopic sinus surgery were applied, respectively. Subjective (questionnaire) and objective (endoscopy and computerized tomography) success rates were used to analyze the results. RESULTS: Septoplasty alone and septoplasty plus endoscopic sinus surgery were applied in 57.7% (15/26) and 42.3% (11/ 26) of the patients, respectively. Success rates were 93.3% (14/15) and 81.8% (9/11), subjectively (p > 0.05), and 66.7% (10/15) and 54.5% (6/11), objectively (p > 0.05), respectively in each group. CONCLUSION: We suggest that septoplasty alone can be adequate for the treatment of CRS with septal deviation.

Detection of Helicobacter pylori and its CagA gene in tonsil and adenoid tissues by PCR.

OBJECTIVE: To determine the presence of Helicobacter pylori and, if detected, the prevalence of the CagA gene in adenotonsillectomy specimens by polymerase chain reaction (PCR). DESIGN: A prospective clinical trial. SETTING: Tertiary referral center. PATIENTS AND METHODS: The study population comprised 23 patients who had undergone adenoidectomy, tonsillectomy, or adenotonsillectomy under local or general anesthesia. Helicobacter pylori DNA was extracted from 3-mm-diameter tissue samples obtained from each tonsil and adenoid tissue specimens. The amplifications were performed for the 16S ribosomal RNA (rRNA) and CagA genes of H pylori in the samples of which H pylori DNA was detected. RESULTS: In examining all the samples, 7 (30%) of 23 patients were shown to be positive for H pylori DNA, 5 (71%) of whom also possessed the CagA gene. CONCLUSIONS: Tonsil and adenoid tissues may be an ecological niche of the mouth without regard to transient or permanent colonization. Oral-oral transmission may be a possible mode of spread of H pylori.

Clinical predictors of long-term success after endoscopic sinus surgery.

OBJECTIVE: Determining the clinical predictors of long-term success after endoscopic sinus surgery (ESS) would better guide the management of patients. METHODS: One hundred-thirty chronic rhinosinusitis (CRS) patients were evaluated retrospectively. Overall subjective improvement was 83% with a mean follow-up of 60 months. Eighty percent had anatomic variations; 36.2%, allergy; 55.4%, nasal polyps; and 26.9%, history of previous operation. The improvement was 100%, 94%, 79.5%, and 69.7% in stages 0, I, II, and III, respectively. With other parameters, the success rates were 68.1% and 91.6% with and without allergy, 73.6% and 94.8% with and without polyps, 54.3% and 93.7% with and without previous history of surgery, 84.4% and 82.7% with and without anatomic variations, and 23.8% and 94.4% with and without recurrent polyps. CONCLUSION: In multivariate Cox regression analysis, allergy (P < 0.05; relative risk, 4.6) and previous polypectomy (P < 0.05; relative risk, 9.9) were found to be predictors of poor prognosis in the long-term follow-up.

A possible role of Helicobacter pylori in chronic rhinosinusitis: a preliminary report.

OBJECTIVE: The objective was to investigate the presence of Helicobacter pylori with polymerase chain reaction in the sinonasal mucosa of patients with or without chronic rhinosinusitis (CRS). STUDY DESIGN: A prospective clinical trial. METHODS: Mucosal tissue samples were collected from ethmoid cells of 12 patients with CRS and the removed mucosal part of the middle concha of 13 patients with concha bullosa who were treated surgically in our institution. DNA extracted from these samples was used for the amplification of 16S ribosomal RNA gene of H pylori by nested polymerase chain reaction. RESULTS: Helicobacter pylori DNA was detected in 4 of 12 patients with CRS, but it was not detected in patients with concha bullosa. Three of four patients with positive results for H pylori had gastroesophageal reflux-related complaints. CONCLUSIONS: It is possible to detect H pylori in the sinus mucosa of some patients with CRS. However, whether H pylori is a causative agent for CRS or a result of CRS is not known.

Antrochoanal polyps in children.

OBJECTIVE: To evaluate the characteristics of antrochoanal polyps (ACPs) in children. METHODS: 10 children operated for ACP were investigated retrospectively. Demographic characteristics, surgical and histopathological findings were evaluated. RESULTS: The mean age was 10.2 years. The antral part of ACP was removed through middle meatal antrostomy in four patients, and transcanine sinuscopy was needed in six patients. It was found that the polyp passed through the main ostium in seven patients and accessory ostium in three patients. The antral part of the polyp was found to be cystic in six patients and polypoid in four patients. There was recurrence of polyps during follow-up period in two cases in which antral part of the polyp was seen to be removed through middle meatal antrostomy during primary surgery. In histologic examination, prominent eosinophilia was detected only in one patient and no mucous gland was detected in any patient. CONCLUSION: Endoscopic surgery through the middle meatal antrostomy combined with transcanine sinuscopy ensures the complete removal of the antral part of ACP in children.