Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction.

BACKGROUND: The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). METHODS: In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18-60) diagnosed with PVH. PVH was diagnosed by evaluating the patients' clinical histories, the findings in the "Micromedical Technologies VisualEyes Spectrum" videonystagmography (VNG) and the "Micromedical Aqua Stim" model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. RESULTS: The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the 'movement velocity' and "direction control" parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient's oscillation averages in the 'toes up' and 'toes down' positions in ADT reduced progressively (p < 0.000). DISCUSSION: This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term.

Assessment of balance after recovery from Covid-19 disease.

OBJECTIVE: To answer the question whether balance related systems have been affected in adults who recovered from Covid-19 disease. This is the first case-control study to assess balance objectively and quantitatively in Covid-19 disease. METHODS: Thirty-seven patients who recovered from Covid-19 disease and 30 healthy controls were compared using Dizziness Handicap Inventory (DHI), Computerized Dynamic Posturography (CDP), Vestibular Evoked Myogenic Potentials(VEMP) and Video Head Impulse Test (v-HIT). RESULTS: On CDP, the composite and visual general scores of the patients were significantly lower than controls (p<0.01). The v-HIT gains of the patients significantly decreased in the vertical semicircular canals compared to controls (p<0.01).There was a significant difference between the patients and controls regarding the absence of o-VEMPs (p<0.01) while the amplitudes and latencies were similar between the groups (p>0.05). Decreased P1/N1 amplitudes and elongated N1 latencies were found on c-VEMP testing (p<0.05). Anosmia, taste disorder and gender were not associated with subjective and objective test results (p>0.05). CONCLUSION: The Covid-19 disease can cause dizziness rather that incapacitating vertigo. Dizziness can be seen in almost one-fifth of the adult covid19 out-patients, which may be due to involvement of vestibular and visual systems,ortheir central connections. The squeals created in the balance related systems may be irreversible as they have persisted after the recovery of the patients. It is also plausible to anticipate more severe condition in the older patients who were treated in the intensive care units. In the long term follow up of the survivors, the need for balance rehabilitation programs should be remembered in order to minimize risks of falling down.

Cervical vestibular-evoked myogenic potentials in patients with essential tremor.

Although different neuroanatomical structures and pathways are emphasized as possible explanations for essential tremor (ET), there is still an ongoing debate. This study aimed to assess the role of brainstem and reflex pathways with cervical vestibular-evoked myogenic potentials (VEMP) in patients with ET. This prospective study included 34 patients with ET and 25 healthy controls. Cervical VEMP was performed in both groups and latencies, inter-peak latency intervals, peak-to-peak amplitudes and asymmetry ratios were recorded. There was statistically no significant difference between the groups in terms of age (38.9 ± 14.9 years vs. 38.9 ± 14.9 years, p = 0.673) and gender (female to male ratio: 14/11 vs. 20/14, p = 0.828). Right N1 latency and right N1-P1 interval were significantly longer in the patient group (p < 0.05). There was a significant positive correlation between the duration of disease and the right N1-P1 interval (p < 0.05). There was no significant difference between the patient and control groups in terms of bilateral P1 latency, left N1 latency, left N1-P1 interval, and bilateral N1 and P1 amplitudes (p˃0.05). Cervical VEMP may reveal the involvement of brainstem and associated reflex pathways in ET.

Predictive Role of Ki-67 and Proliferative-Cell Nuclear Antigen (PCNA) in Recurrent Cholesteatoma.

OBJECTIVES: To investigate the potential use of Ki-67 and pronuclear cell antigen (PCNA) as indicators of recurrent cholesteatoma. MATERIAL AND METHODS: Patients who had been diagnosed with cholesteatoma and who had undergone canal wall-down mastoidectomy were included in this study. Subjects were divided into two groups: recurrent and non-recurrent (i.e., cases without recurrence for at least 2 years). Ossicular pathologies were recorded. Histopathologic specimens were stained for Ki-67 and PCNA and the percentages of stained cells were calculated. RESULTS: Neither group demonstrated a significant difference in terms of total Ki-67 per cell, Ki-67-stained cell counts, Ki-67-staining percentages, total PCNA per cell, PCNA-stained cell counts, or PCNA-staining percentages (p>0.05). No significant relationship was noted between the staining percentages for either Ki-67 or PCNA and the incudostapedial involvement (p>0.05); however, a significant relationship was noted between Ki-67 staining and malleus involvement (p<0.05). CONCLUSION: Although the recurrent and non-recurrent cholesteatoma groups showed no significant differences in terms of the percentages of stained cells for either Ki-67 or PCNA, we detected high Ki-67 staining in the malleus involvement group. We concluded that cell-proliferation markers could not be defined as indicators of recurrence of cholesteatoma, but they could be defined as indicators of destructive patterns of this disease.

Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) Evoked by Air-Conducted Stimuli in Patients with Functional Neck Dissection.

OBJECTIVE: Cervical vestibular-evoked myogenic potentials (cVEMPs) are short-latency vestibulocollic reflexes. The damage on any point of the vestibulocollic reflex pathway could affect the cVEMPs. Whether neck dissection has an effect on the sacculocollic pathway, and consequently on cVEMPs, remains unexplored. The aim of this study was to evaluate the cVEMP findings in patients with functional neck dissection without vestibular symptoms. PATIENTS AND METHODS: This cross-sectional study design, 20 patients who had undergone unilateral neck dissection with sparing of the accessory nerve, SCM and internal jugular vein, were included. The response rates (%), cVEMPs parameters such as the prestimulus background EMG [Root mean square (RMS)] activity (µV), P13 and N23 peak latencies (ms), interpeak (N23-P13) interval (ms), scale and non-scale interpeak (N23-P13) amplitudes (µV) were compared between the groups. Amplitude asymmetry ratio (AAR) was calculated. RESULTS: Twenty patients (14 males and 6 females), age was between 38 and 79 years were included in the study. All of the patients had clear cVEMPs on the NOS, whereas 18/20 (90%) patients had on the NDS. P13 and N23 peak latency of the NDS were found to be significantly longer than the NOS (P = 0.01). There was no significant difference in N23-P13 interpeak interval between two sides (P > 0.05). There was a negative correlation between P13 peak latency and post-operative time (P = 0.042; R = ­0.484). Scale and non-scale N23-P13 interpeak amplitudes of the NDS were found to be significantly lower than the NOS (P = 0.03). Mean AAR was found as 0.28 ± 0.16 (0.08-0.76). Seven patients (35%) had abnormal amplitude asymmetry. RMS values, were statistically and significantly lower in NDS compared to NOS (P = 0.01). However, no correlation was observed between the RMS values and peak latency and peak amplitude values (P > 0.05). CONCLUSIONS: cVEMP testing is an easy-to-apply, non-invasive, painless, and recordable test that can be used for evaluations of SAN and SCM function for patients undergoing neck dissection. After neck dissection, VEMP abnormalities can be detected. However, further studies are needed to indicate whether these abnormalities originate within the vestibular system and are due to pathologies originating from the SANs and SCMs. In addition, preoperative and postoperative studies are needed to better guide the clinical application of cVEMP testing.

Contribution of intratympanic steroids in the primary treatment of sudden hearing loss.

OBJECTIVE: The primary objective is to investigate the contribution of intratympanic steroids in the primary treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). The secondary objective is to compare methylprednisolone (MP) and dexamethasone in terms of their effectiveness and injection-site pain. METHODS: Two hundred and four patients with ISSNHL, 144 patients underwent systemic steroid therapy (SST) alone and 60 patients underwent combined therapy (CT). The effectiveness of the treatment was assessed according to the Furuhashi criteria. Injection-site pain after the procedure was assessed at 5 and 60 min on a visual analog scale (VAS). RESULTS: Successful recovery was 55% in the CT group and 34% in the SST alone group (p = .004). Patients whose initial hearing level is severe, the success rate was statistically significantly higher with CT (p = .0001). Hearing improvement differed significantly between the MP and dexamethasone (p = .015). Injection-site pain at 5 min after the procedure, higher VAS scores were obtained with MP (p = .002). CONCLUSION: In the primary treatment of sudden hearing loss, in which the level of hearing loss is 70-89 dB HL, the addition of ITS to the treatment significantly increased the success rate. The pain occurring in the middle ear was high but tolerable in the first few minutes by MP.

The Role of Fetuin-A and Electrolytes in the Etiology of Sialolithiasis.

Objective The aim of this study was to investigate serum and saliva fetuin-A, protein, and electrolyte levels in patients with sialolithiasis. Study Design Prospective randomized controlled study. Setting Tertiary center. Subjects and Methods Twenty patients with recurrent sialadenitis secondary to submandibular salivary gland stones and 20 asymptomatic healthy volunteers without salivary gland stones were included in the study. Bimanual palpation and ultrasonography were performed in the patient and control groups. The electrolyte, protein, and fetuin-A levels of the serum and saliva were measured. Results The serum calcium, phosphorus, and potassium levels of the patients were significantly lower than those of the control group (respectively, P = .04, P = .01, P = .04). There was no statistically significant difference between the serum fetuin-A levels of the 2 groups ( P = .06). The saliva phosphorus values of the patients were higher than those of the control group ( P = .05), as were their saliva fetuin-A and total protein values ( P = .001, P = .01). A positive correlation was determined between the saliva fetuin-A levels and the saliva phosphorus and potassium levels of the patients ( P = .04, P = .02). The magnesium level, which has been argued to be a factor in the prevention of calcification, showed an increased correlation with the total protein in the patient group ( P = .02). Conclusion It is possible that the high levels of saliva fetuin-A, total protein, and phosphorus with insufficient of saliva magnesium levels may make a contribution to the formation of sialoliths.

Do Vestibular-Evoked Myogenic Potential Abnormalities in Patients with Cochlear Implant Only Reflect Saccular Dysfunction?

OBJECTIVE: The objective of this study was to explore the usefulness of 1000-Hz tone burst (TB) stimuli for detecting cervical vestibular-evoked myogenic potential (cVEMP) abnormalities in patients with a cochlear implant (CI). MATERIALS AND METHODS: Thirty asymptomatic patients who received unilateral CI because of severe bilateral sensorineural hearing loss were assessed for cVEMP produced by TB stimuli at two frequencies (500 and 1000 Hz) in the airway. VEMPs were recorded when the devices were switched to the on (CI-on) and off (CI-off) positions. RESULTS: At the CI-on position, the surgical side (SS) 500-Hz response rates (15/30) were significantly higher than the SS 1000-Hz response rates (9/30) (p=0.031), while the non-operated control side (CS) 500-Hz response rates (20/30) were higher than the CS 1000-Hz response rates (18/30), but the difference was not significant (p=0.50). At the CI-on position, the SS 500-Hz response rates (15/30) were lower than the CS 500-Hz response rates (20/30), but the difference was not significant (p=0.063). However, the SS 1000-Hz response rates (9/30) were significantly lower than the CS 1000-Hz response rates (18/30) (p=0.004). When there was no significant difference between the 500-Hz amplitudes on either side, the SS 1000-Hz amplitudes were found to be significantly lower (p=0.04). CONCLUSION: CIs have the potential to cause mechanical damage and electrical stimulation to the vestibular system. Possible implant-mediated mechanical damage and electrical stimulation in the high-frequency region affecting the cVEMP response could be found by a 1000-Hz stimulus.

Malleus to Stapes Bone Cement Rebridging Ossiculoplasty: Why Don't We Perform Frequently?

OBJECTIVE: To evaluate the effectiveness of malleus to stapes bone cement rebridging (MS-BCR) for Austin Kartush group A ossicular defects and compare the audiological results with incus interposition (IP) and incus to stapes bone cement rebridging (IS-BCR). METHODS: Patients for whom type 2 tympanoplasty had been performed in a tertiary referral center were examined. Revision cases and those with graft failure were excluded. Three treatment groups were IS-BCR, IP, and MS-BCR. Preoperative and postoperative audiological results were compared. RESULTS: A total of 92 patients were enrolled. The IS-BCR was performed in 42 (45.65%), IP in 18 (19.56%), and MS-BCR in 32 (34.78%) patients. Postoperative mean air bone gap was 20.1 ± 9.8 dB HL and did not differ significantly between the groups (P = .271). Postoperative mean air bone gap less than 20 dB HL was achieved in 23 (54.7%) patients in IS-BCR, 10 (55.5%) patients in IP group, and 24 (75%) patients in MS-BCR group (P = .06). Mean closure in air bone gap was 14.0 ± 11.6 dB HL. The changes in mean and frequency-specific air bone gap were not significantly different between treatment groups (P > .05). CONCLUSION: Malleus to stapes bone cement rebridging may provide hearing results comparable to IS-BCR and IP.

Temporal Bone Localized Chondroblastoma.

Chondroblastoma is a highly destructive tumor originating from immature cartilage cells. Although chondroblastoma is defined as a benign tumor, it may exhibit malign tumor behaviors such as invasion or metastasis on neighboring structures. Magnetic resonance (MR) image is a solid mass lesion, which included heterogeneous hypointense in T2A and heterogeneous minimal hyperintense in T1A with destructive expansile characteristics and millimetric calcifications. Temporal bone chondroblastomas may complicate the diagnosis because of their different histologic characteristics. Microscopically, chondroblastic cell nests and calcification of locally "chicken wire" type around the cells are observed. These tumors secrete s-100 and vimentin and are used for differential diagnosis. In this study, a temporal bone localized chondroblastoma case is presented.

Investigation of poly (ADP-ribose) polymerase-1 genetic variants as a possible risk for allergic rhinitis.

Recent studies point toward the involvement of poly (ADP-ribose) polymerase-1 (PARP-1) in the pathogenesis of allergic airway inflammation, such as asthma and allergic rhinitis (AR). It has been suggested that inhibition of PARP-1 provides significant protection against systemic or tissue inflammation in animal models. The objective of this study was to investigate whether single-nucleotide polymorphisms of PARP-1 gene are associated with genetic susceptibility to AR. We studied the effect of promoter variations and Val762Ala polymorphism of the PARP-1 gene on the risk for developing AR in a case-control association study with 110 RA patients and 130 control subjects in a Turkish population. The polymorphisms of 410 C/T, -1672G/A, and Val762Ala in the PARP-1 gene were analyzed using the polymerase chain reaction-restriction fragment length polymorphism method. Haplotype analysis of these groups was also performed. The results were statistically analyzed by calculating the odds ratio (OR) and their 95% confidence intervals using χ(2) tests. The heterozygote genotype of the promoter polymorphism (-1672) was significantly found to be associated with susceptibility to AR (OR: 0.56) among the tested single-nucleotide polymorphisms. Haplotypes of PARP-1 -410, -1672, and 762 were not associated with an increased risk for AR. These results raise the possibility that the promoter (-1672) polymorphism of the PARP-1 gene may be a risk factor for AR.

Otoacoustic emission responses of the cochlea to acute and total ischemia.

In the present experimental study, we sought to monitor distortion product otoacoustic emissions (DPOAEs) as an indicator of cochlear function, after sudden, total, and irreversible interruption of cochlear blood flow, to provide information on the time course of cochlear response to ischemia. Twenty rats with normal hearing function were included. Complete and abrupt ischemia was provided by decapitation. DPOAEs at 3-8 kHz frequencies were recorded at baseline and exactly every consecutive minute after decapitation, until emissions in all frequencies disappeared completely. Mean DPOAE values decreased significantly and progressively after decapitation for all frequencies. The mean duration of emissions was 8.20 ± 1.96 min (minimum 3 min, maximum 11 min). The longest durations of DPOAEs were observed with 4 and 5 kHz frequencies, and 3 and 6 kHz had the shortest durations. The outer hair cells exposed to acute ischemia seem to exhibit a rapid functional loss; thus, cautious handling of the cochlear vasculature and surrounding structures is necessary in surgical interventions. Additionally, our results provide some idea of the normal tolerance range of the cochlea to ischemia, which could be useful for future studies.

Serum levels of advanced oxidation protein products in response to allergen exposure in allergic rhinitis.

Patients with asthma, allergic rhinitis, or atopic dermatitis experience increased oxidative stress. We conducted a prospective study to examine the levels of advanced oxidation protein products (AOPPs) as an indicator of oxidative stress in 97 patients with allergic rhinitis who were followed in our clinic during a 3.5-month period. Of these 97 patients, 51 were treated with subcutaneous immunotherapy (SCIT), and 46 did not receive any treatment until the study was concluded. In each patient, allergic rhinitis and allergic sensitization were documented by the history, the findings on clinical examination, and the results of blood and skin-prick tests. Blood samples from each patient were analyzed to determine AOPP levels. We found that the mean serum AOPP level was significantly higher in the SCIT group than in the non-SCIT group (258.55 vs. 163.83 µmol/L; p = 0.0015). We conclude that as a known indicator of protein oxidation, the serum AOPP level is a marker of increased oxidative stress in response to allergen exposure in allergic rhinitis.

Effect of nasal mometasone furoate on the nasal and nasopharyngeal flora.

OBJECTIVE: Mometasone furoate (MF) is one of the commonly used topical steroids, particularly for patients with allergic rhinitis. However, its effect on the colonization of bacteria that may cause superinfections by suppressing the local immunity is not known. Thus, we investigated the effect of MF use on the nasal and nasopharyngeal microbial flora. MATERIALS AND METHODS: Swab samples were taken from 35 patients who required MF monotherapy, just before and after one month of the treatment. Samples were maintained in Stuart's medium. Each swab was transferred to 1ml of a sterile saline solution, then into the standard agar. After incubation under 5% carbon dioxide at 37°C, colony number was detected per ml. RESULTS: Colony counts of nasal or nasopharyngeal microbial flora did not show any statistically significant alteration with one month use of MF. However, an increase in potential pathogens as well as normal flora bacteria was determined in five of the patients and six patients acquired new nasopharyngeal potential pathogens, mostly Moraxella catarrhalis, Pseudomonas aeruginosa and Staphylococcus aureus, following the use of MF. CONCLUSION: The use of MF for one month did not statistically significantly change the nasal and nasopharyngeal flora. This study indicates that MF could be increase the colonization of the potential pathogens in some of the patients at the subclinical level particularly in the nasopharyngeal area.

Midterm outcomes of outfracture of the inferior turbinate.

OBJECTIVE: A variety of medical and surgical treatment alternatives exists for the management of inferior turbinate hypertrophy, indicating a lack of consensus on the optimal technique. The purpose of the present study was to evaluate the inferior turbinate objectively by means of radiologic methodology during the early and late periods in patients treated with inferior turbinate outfracture. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Eighty inferior turbinates of 40 patients (28 males, 12 females) who underwent surgery because of septum deviation and inferior turbinate hypertrophy were included in this prospective clinical study. All patients were evaluated by paranasal sinus computed tomography preoperatively and at one and six months postsurgery. The angle and the distance between the inferior turbinate and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone were measured on the coronal plane anterior posteriorly at five different anatomic levels. RESULTS: Statistically significant reductions were noted in the angle and distances in all sections one and six months postoperatively when compared with the preoperative measurements (P < 0.005). CONCLUSION: Compared with the preoperative status, those patients who underwent turbinate outfracture procedures displayed a reduction in the angle and the distance between the inferior turbinate bone and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone one month following surgery. Ongoing outcomes of this treatment method have been objectively shown.

Medical treatment of adenoid hypertrophy with "fluticasone propionate nasal drops".

BACKGROUND: Adenoid hypertrophy treatment for children is generally planned in accordance with the degree of airway obstruction and related morbidity. If surgical treatment is indicated, the individual risk/benefit analysis of patients should be assessed in terms of anesthetic and postoperative complications. Although there are few alternative treatment options, these may be considered as a nonsurgical approach in less serious cases. Accordingly, studies about intranasal steroid applications under various protocols have been presented. STUDY DESIGN: The prospective, randomized, placebo-controlled study. SETTING: Tertiary referral center. PATIENTS AND METHODS: Patients indicated for surgery were randomly divided into two groups. The study group was treated by fluticasone propionate nasal drops (NSD-nasal steroid drops) of 400 microg/day for 8 weeks. The control group was treated by normal saline (NS) in the same way. All the patients were called for follow-up every 4 weeks. RESULTS: At the end of 8 weeks, statistically significant improvement (p<0.05) was observed in the NSD treated group compared to the NS treated group in terms of nasal airway obstruction, mouth breathing, speech abnormalities, apnea and night cough. At the end of 8 weeks, the average total symptoms score of the NSD treated group dropped from 13.7 to 2.9 while the NS treated group's score changed from 14.8 to 14.6. After 8 weeks of NSD treatment the initial adenoid/choana (A/C) rate had dropped from 87 to 56% and a total decrease of 35.6% was observed. After 8 weeks of NS treatment the A/C rate dropped from 87 to 85% and a total decrease of 2.2% was observed. CONCLUSIONS: In this study, the effect of fluticasone propionate nasal drops on adenoid hypertrophy is examined for the first time. This method provides an effective alternative to surgical treatment in children with adenoid hypertrophy. With the protocol applied in this study 76% of the patients were eliminated the surgery and removed from the surgical waiting list.

[Distortion product otoacoustic emissions results in children with middle ear effusion]. / Seröz otitis mediali çocuklarda distorsiyon ürünü otoakustik emisyon sonuçlari.

OBJECTIVES: To evaluate the role of distortion product otoacoustic emissions (DPOAE) results in children with middle-ear effusion before and after ventilation tube insertion. PATIENTS AND METHODS: The study was conducted between the September 2007 and May 2008 at the Otolaryngology Clinic diagnosed with middle-ear effusion. A prospective study was carried out 30 patient (18 males, 12 females; mean age 8.6 years; range 6 to 15 years) and a total of 41 ears with middle-ear effusion. A total of 30 ears of 15 volunteers healthy control group (8 males, 7 females; mean age 7.8 years; range 5 to 15) included in the study. All children listed for appropriate surgery had a pre- and postoperative (four week after) tympanometry, pure tone audiometry and DPOAE recorded. A comparison was made between control group DPOAE value and pre- and postoperative DPOAE value of patient. RESULTS: Preoperatively, 41 ears had an abnormal tympanometry of which 80% had absent DPOAE. After four week all postoperative patients with surgery had 92.6% a normal DPOAE. Control group of 29/30 ears had a normal (96.7%) DPOAE. CONCLUSION: Patients with otitis media with effusion measured preoperative DPOAE, postoperative after one month all patients with grommets had a more DPOAE value comparison with preoperative, but less for control group.

[Assessment of internal jugular vein flow and patency with power duplex Doppler ultrasonography after functional neck dissection]. / Internal juguler ven akimi ve devamliliginin fonksiyonel boyun diseksiyonu sonrasinda power dubleks Doppler ultrasonografi ile degerlendirilmesi.

OBJECTIVES: The purpose of this study was to assess the patency of the internal jugular vein after functional neck dissection. PATIENTS AND METHODS: Twenty-five patients (6 females, 19 males; mean age 53.9 years; range 30 to 71 years) who were operated on because of larynx, hypopharynx and intraoral cavity tumors in the Ear, Nose and Throat Clinic of Haseki Training and Research Hospital between January 2001 and March 2003 were included in the study. Internal jugular veins were evaluated after 42 functional neck dissections. By means of power duplex Doppler ultrasonography, the jugular blood flow, presence or absence of a thrombus, diameter of the vein, velocity of the blood flow were evaluated. RESULTS: In our study the internal jugular vein patency rate was found to be 95.2%, and thrombosis was detected only in two patients. Blood flow velocity in patients with thrombus was found to be significantly lower than that observed in patients without thrombus (p<0.05). CONCLUSION: It was observed that blood flow of the internal jugular vein was ensured in most patients after functional neck dissection.

Role of nasal muscles in nasal valve collapse.

OBJECTIVE: This study was performed to determine the role of nasal muscle function in patients with dynamic or static nasal valve collapse by comparing the electromyographic activities of nasal muscles in healthy individuals. STUDY DESIGN: Cross-sectional clinical study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Twenty adult patients with dynamic nasal valve collapse, 18 patients with unilateral static nasal valve stenosis (septum deviation), and 20 healthy adults were included in the study. The activity of their nasal muscles was measured by surface electromyography (EMG), and the results were compared for the patient and control groups. RESULTS: No abnormal finding was found in any of the nasal muscles of the control group. In the majority of patients with dynamic nasal valve pathology, statistically significant functional disorders were detected in the m dilator naris anterior and m nasalis transversalis muscles compared with the controls. During inspiration and expiration in patients with static nasal valve pathology, some revealed muscular abnormities during inspiration. Normal muscle activation was observed in all of the patients during expiration. CONCLUSION: Determination of agents involved in pathologies of the nasal valve region is necessary for planning appropriate treatment. The role of nasal muscles in dynamic nasal valve pathologies, which has not been previously recognized, should be considered. A more effective and adequate solution for the nasal sidewalls than static pathologies should be considered in these patients by taking into account the muscular activity disorders detected by EMG at the stage of surgical treatment.

Advanced oxidation protein products as an oxidative stress marker in allergic rhinitis.

OBJECTIVES: This study was designed to compare the levels of dityrosine-containing protein cross-link products, also known as advanced oxidation protein products (AOPP); in patients with allergic rhinitis with those in healthy individuals considering the fact that AOPP has the potential to be a marker of oxidative stress specific to proteins in mammalian systems. PATIENTS AND METHODS: This study was performed on 40 patients (18 males, 22 females; mean age 29 years; range 10 to 53 years) with allergic rhinitis admitted to our clinic between December 2008 and January 2009 and on 40 healthy volunteers (16 males, 24 females; mean age 31 years; range 13 to 48 years). Skin prick test was performed to establish a diagnosis of allergic rhinitis in patients with major symptoms and allergic sensitization was also supported with serum IgE levels. Blood samples were obtained and examined in all patients to determine AOPP. RESULTS: Serum AOPP levels were significantly higher in patients with allergic rhinitis (169.0+/-14.2 micromol/L) compared to controls (43.9+/-3.5 micromol/L; p<0.001). In addition, mean serum IgE levels of patients with allergic rhinitis (308.2+/-38.5 IU/ml) were found to support the presence of allergic sensitization. CONCLUSION: Determining the levels of serum AOPP, a well-known marker of protein oxidation, appears to be a useful method in determining the role of oxidative stress in the etiopathogenesis of allergic rhinitis.