First-choice treatment in mild to moderate obstructive sleep apnea: single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction or nasal continuous positive airway pressure.

OBJECTIVE: To compare the efficacy of single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) for the soft palate and base of the tongue with that of nasal continuous positive airway pressure (CPAP) in primary treatment of mild to moderate obstructive sleep apnea. DESIGN: A prospective nonrandomized clinical study. SETTING: Tertiary care referral center. PATIENTS: Data from 47 patients with mild to moderate obstructive sleep apnea treated between January 1, 2003, and October 31, 2006, were reviewed. INTERVENTIONS: Twenty-six patients underwent TCRFTVR and 21 underwent nasal CPAP as a primary treatment modality. MAIN OUTCOME MEASURES: Baseline and 12-month posttreatment measurements using the Epworth Sleepiness Scale and polysomnography were compared. RESULTS: The baseline characteristics of the groups were not significantly different. Both methods showed meaningful results for the Epworth Sleepiness Scale and polysomnography variables 12 months after treatment compared with baseline measurements. The results were not significantly different in the posttreatment intergroup comparisons. Treatment success rates were 52.4% for nasal CPAP and 53.8% for TCRFTVR (P = .92). CONCLUSION: Similar comparison results with nasal CPAP in objective and subjective variables make single-stage, multilevel TCRFTVR a good alternative in primary treatment of mild to moderate obstructive sleep apnea.

The preventive effect of ginkgo biloba extract in myringosclerosis: study in rats.

OBJECTIVE: To determine the preventive effect of Ginkgo biloba extract in the formation of myringosclerosis. STUDY DESIGN: Prospective, randomized clinical study. MATERIALS AND METHODS: Posterosuperior quadrant of tympanic membranes of twenty-five Wistar Albino rats were bilaterally myringotomized. They were divided into three groups randomly. Groups 1 and 2 were administered 100 mg/kg/day and 200 mg/kg/day systemic Ginkgo biloba extract. The third group was treated with 1 mL/day saline solution. After 10 days of treatment, myringotomized membranes were examined by otomicroscopy and harvested. They were evaluated histopathologically by light microscopy and compared according to the occurrence of myringosclerotic plaques and the thickness of membranes. RESULTS: Tympanic membranes of groups 1 and 2 nearly had no existence of myringosclerosis (72.2% in group 1 and 83.3% in group 2, P = 0.434). However, in group 3, only 14.3 percent had no myringosclerosis (P < 0.001). Thickness of membranes in group 1 was 0.13 +/- 0.25, group 2 was 0.06 +/- 0.02, and group 3 was 0.19 +/- 0.35 mm. Group 3 had significantly thicker membranes compared with groups 1 and 2 (P < 0.001 for group 2 and P = 0.003 for group 1). CONCLUSION: Formation of experimental myringosclerosis was reduced or inhibited and tympanic membranes were thinner after systemic Ginkgo biloba extract administration.

The expression of MMP-2, MMP-7, MMP-9, and TIMP-1 in chronic rhinosinusitis and nasal polyposis.

OBJECTIVES: To investigate the expression and clinical significance of MMP-2, MMP-7, MMP-9, and TIMP-1 in patients with nasal polyposis (NP) and chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: This study involved 54 patients. There were three groups: nasal polyposis group, chronic rhinosinusitis group, and control group. Specimens were collected during endoscopic sinus surgery. Each sample was immunohistochemically examined. RESULTS: Expression of MMP-2 was found significantly increased in NP, whereas MMP-7 expression was found significantly increased in CRS (P < 0.001). TIMP-1 was significantly high in control group compared to CRS and NP (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Different regulation type of activation of MMPs has been found in these two diseases. If MMP-2 expression is intense in the mucosa, then this ends with polyp formation; if MMP-7 expression is intense, it ends with CRS or stays as CRS.

The effect of stapes mobility on hearing outcome and which procedure to choose in fixed stapes in children tympanosclerosis.

OBJECTIVES: Our objective was to evaluate the features of tympanosclerosis in children and to determine the effect of stapes mobility and the type of one-stage operation on hearing outcomes. MATERIALS AND METHODS: Fifty-one children who were performed different types of single-stage otologic surgery for tympanosclerosis between January 1997 and December 2006 were retrospectively chart reviewed. The children were divided into two groups according to the mobility of ossicular chain, especially the stapes. Stapes fixed group was also evaluated in detail according to the type of surgery that was performed. Patients who had previous ventilation tube insertion, tympanic membrane parasynthesis or any other otologic surgery were excluded from the study. Improvement of the hearing by at least 10 dB and air-bone gap less than 20 dB were accepted as success criteria after 24 months of follow-up period. RESULTS: The air conduction levels, and the air-bone gap values of both groups were improved significantly after the single-stage operations. Pure tone averages pre- and postoperatively for stapes mobile group were 45.55+/-15.96 and 34.50+/-16.64 dB (p=0.002); and in stapes fixed group these were respectively 43.97+/-13.45 and 33.16+/-12.14 dB (p<0.001). When pre- and postoperative air-bone gap levels were evaluated it was seen that in both groups they were improved more than 10 dB, from 34.10+/-11.37 to 23.05+/-12.32 dB (p=0.002) in stapes mobile group and from 35.29+/-11.65 to 24.48+/-12.50 dB (p<0.001) in stapes fixed group. In stapes fixed group air-bone gap was less than 20 dB in 11 of 23 (47.8%) patients who had mobilization and 3 of 8 (37.5%) patients who had small fenestra stapedotomy operations. Although it was not statistically significant, gain was more than 10 dB only in 2 of 8 (25.0%) patients in the stapedotomy group but 14 of 23 (60.9%) patients in mobilization group (p=0.698 for ABG and p=0.220 for gain). The change in the bone conduction levels were improved 0.75 dB in group 1 and got worse 0.52 dB in group 2 and this was not statistically significant (p=0.239). CONCLUSIONS: In this study about children, the status of stapes and the place of tympanosclerotic mass had no significant negative effect on hearing improvement. You can perform mobilization in one-stage if you are experienced and have to prefer second-stage surgery if stapes is fixed and stapedectomy is needed.

Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy.

OBJECTIVES: To compare the efficacy of submucosal temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) and resection with microdebrider (SMRM) in chronic inferior turbinate hypertrophy. STUDY DESIGN: Prospective, randomized, and single-blinded clinical trial. METHODS: The study group consisted of 30 symptomatic patients who underwent simultaneous TCRFTVR and SMRM for consecutive sides. Visual analogue scale (VAS) and acoustic rhinometry (ARM) were made preoperatively and at 12th week and 6th month postoperatively; saccharine transport time (STT) and ciliary beat frequency (CBF) were performed at 12th week and 6th month postoperatively. The rate of the need for the revision operation was determined between 6 and 12 months period postoperatively. RESULTS: Significant improvement was achieved in VAS scores and ARM measurements after both procedures, whereas both parameters did not differ significantly between two procedures postoperatively. STT and CBF showed no significant post-treatment variation in comparison of the intergroup measurements. The rates of the need for revision operation were not significantly different. CONCLUSION: Identical results in objective and subjective parameters were observed for both techniques.

Bilateral congenital choanal atresia in a 7-day-old patient: transnasal endoscopic repair with stent.

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This paper is a case report of a 7-day-old full term girl infant presenting the history of attacks of cyanosis and having difficulty in suckling and respiration. On examination, alternating cyanosis and normal colour was observed in the patient. The application of nelaton cannulas bilaterally revealed the diagnosis of bilateral CCA. Transnasal endoscopic repair with stents was performed. Symptomatic resolution persists 6 months postoperatively.

Success is a matter of experience: type 1 tympanoplasty : influencing factors on type 1 tympanoplasty.

Our objective was to identify the factors that could influence the success rate of type 1 tympanoplasty in a tertiary care centre where both residents and senior surgeons perform this operation. Six hundred and seven patients who had been performed type 1 tympanoplasty as a primary otologic surgery between January 1997 and December 2004 were retrospectively chart reviewed. The patients had intact and mobile ossicular chain peroperatively. Patients with any other macroscopic otologic pathology like cholesteatoma, granulation in the middle ear and osteitis in mastoid cells were excluded from the study. Dry ear, intact and mobile tympanic membrane, improvement of the hearing by at least 10 dB and air-bone gap less than 25 dB were accepted as success criteria after 12 months of follow-up period. Chi-square test was used for statistical comparison of the different influencing factors. The male gender, younger age, smaller-sized perforations and experience of the surgeon were stated as good prognostic factors due to statistical evaluation. Afterwards the data of the study group was reanalysed in order to decide the cases for the residents. Finally, it was observed that seniors had better results in cases with perforations greater than 50%, dry ears and patients older than 16 years. In training and research clinics where both residents and senior surgeons perform type 1 tympanoplasty, the rate of success can be enhanced if patients with perforations greater than 50%, dry ears and patients older than 16 years are operated by the senior surgeons. The reason for this is that these groups have the overall worse results and should by argument be done by senior surgeons.

Infected inferior turbinate pneumatization.

With the widespread utilization of endoscopic nasal surgery, the interest in nasal structures has increased. Inferior turbinate pneumatization is among the most rare causes of nasal obstruction. In the current literature, there are only ten reported cases of inferior turbinate pneumatization. A 52-year-old male patient presented with nasal obstruction, purulent nasal discharge, facial pain and headache. Anterior rhinoscopic examination showed bilateral middle and inferior turbinate hypertrophy and edema of the nasal mucosa. Computed tomography (CT) revealed bilateral frontal, anterior and posterior ethmoidal and maxillary sinusitis with bilateral concha media bullosa and right infected inferior turbinate pneumatization. In this report, infection of this rare anatomical abnormality is presented for the first time and documented with acoustic rhinometry, CT and peroperative photography.

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.