The Role of Real-Time Elastography in the Differential Diagnosis of Salivary Gland Tumors.

OBJECTIVES: The aim of the study was to scrutinize the value of qualitative elastography in the diagnosis of salivary gland masses. METHODS: Sixty patients were enrolled in this prospective study. Patients aged between 1 and 91 years (mean age, 48.8 ± 20.48) with a salivary gland mass were studied with real-time elastography. All patients were examined by 1 examiner, blinded to all relevant data. On elastography, masses were scored into 4 types according to their stiffness compared to normal tissue. Scores of 3 and 4 were accepted as signs of malignancy. Sensitivity, specificity, and positive and negative predictive value were calculated for elastography in verifying malignancy. RESULTS: Forty-two percent of the masses were located in the parotid, and the rest in submandibular gland. The diameter of the lesions varied between 12 and 60 mm (mean, 24.36 ± 11.98 mm). Forty-four masses were benign (73%), and among them the majority were inflammatory lesions (31 of 60; 51.7%). There were 16 malignant lesions (27%). On elastography, not only all malignant lesions but 15 benign lesions were scored as 3 to 4. All masses scored as 1 to 2 were benign. Sensitivity was 100%; specificity, 66%; positive predictive value, 52%; and negative predictive value, 100%. When only Score 4 lesions were accepted as malignant, these values became 75%, 77%, 55%, and 90%, respectively. CONCLUSIONS: Elastography alone cannot be used to discriminate malignant from benign in the evaluation of salivary gland lesions. However, with its high negative predictive value, it may be used as an adjunct tool to increase the diagnostic value of ultrasonography.

Effect of Pycnogenol® on an experimental rat model of allergic conjunctivitis.

BACKGROUND: Allergic conjunctivitis (AC) is a frequent and challenging disease in ophthalmology practice. Cell protective effect of Pycnogenol® (PYC) depends on its antioxidant and anti-inflammatory properties. The aim of the study is to investigate the effect of PYC on an experimental AC model. METHODS: Ovalbumin and Al(OH)3 were given seven times intraperitoneally (i.p.) every other day and ovalbumin installed everyday directly on conjunctiva to create an AC rat model. Then, PYC (3 or 10 mg/kg i.p.) was applied in the study groups. Control rats were given adjuvant Al(OH)3 i.p. and topical saline on conjunctiva. A negative control group in which only PYC (10 mg/kg/7 days) was administered i.p. and an AC positive control group which have been given dexamethasone (1 mg/kg/7 days) was created. Mast cells were counted with a microscope; histological evaluation was performed with H-E and toluidine blue, mast cell tryptase, and TNF-α and TGF-ß staining. RESULTS: Pycnogenol treatment alone did not show any detrimental effect. Mast cell count (MCC) decreased in both dexamethasone and 10 mg/kg given PYC treatment groups compared to positive control group and these results were statistically significant (MCC 1.85 ± 0.69, p < 0.001; 2.42 ± 0.53, p = 0.003). Negative staining with TGF-ß and weak focal staining with TNF-α were the common findings of dexamethasone and PYC treatment groups. CONCLUSIONS: The animal model of AC was successfully developed by using aforementioned way. PYC is a safe herbal product and it has alleviated the findings of ovalbumin-induced AC-similar to dexamethasone-histologically in this experimental model. These results are promising for the future of AC treatment.

Functional Rhinoplasty.

Understanding nasal anatomy and physiology are the most important points for successful functional rhinoplasty. Anatomic structures playing major roles in nasal breathing functions include the septum, and internal and external nasal valves, so physical examination of these regions is essential. Planning for functional rhinoplasty involves the identification of the sites of nasal airway obstruction or old trauma, and addressing those regions during the operation with a number of different techniques that have been described.

Screening Fabry's disease in chronic kidney disease patients not on dialysis: a multicenter study.

OBJECTIVES: Fabry's disease is an X-linked inherited, rare, progressive, lysosomal storage disorder, affecting multiple organs due to the deficient activity of α-galactosidase A (α-Gal A) enzyme. The prevalence has been reported to be 0.15-1% in hemodialysis patients; however, the information on the prevalence in chronic kidney disease not on dialysis is lacking. This study aimed to determine the prevalence of Fabry's disease in chronic kidney disease. METHODS: The patients older than 18 years, enclosing KDIGO 2012 chronic kidney disease definitions, not on dialysis, were enrolled. Dried blood spots on Guthrie papers were used to analyze α-Gal A enzyme and genetic analysis was performed in individuals with enzyme activity ≤1.2 µmol/L/h. RESULTS: A total of 1453 chronic kidney disease patients not on dialysis from seven clinics in Turkey were screened. The mean age of the study population was 59.3 ± 15.9 years. 45.6% of patients were female. The creatinine clearance of 77.3% of patients was below 60 mL/min/1.73 m2, 8.4% had proteinuria, and 2.5% had isolated microscopic hematuria. The mean value of patients' α-Gal A enzyme was detected as 2.93 ± 1.92 µmol/L/h. 152 patients had low levels of α-Gal A enzyme activity (≤1.2 µmol/L/h). In mutation analysis, A143T and D313Y variants were disclosed in three male patients. The prevalence of Fabry's disease in chronic kidney disease not on dialysis was found to be 0.2% (0.4% in male, 0.0% in female). CONCLUSION: Fabry's disease should be considered in the differential diagnosis of chronic kidney disease with unknown etiology even in the absence of symptoms and signs suggestive of Fabry's disease.

Antibiotics in eosinophilic chronic rhinosinusitis: Rethinking maximal antimicrobial medical therapy.

OBJECTIVES/HYPOTHESIS: Eosinophilic chronic rhinosinusitis (eCRS) has recently been recognized as a CRS subtype characterized by inflammation rather than chronic infection. Consequently, the role of antibiotics as a component of maximal medical therapy for eCRS has been called into question. The purpose of this study was to investigate whether the use of antibiotics, which lack any secondary anti-inflammatory properties, are useful in the treatment of eCRS. STUDY DESIGN: Prospective individual cohort study. METHODS: Institutional review board-approved, prospective study of 39 patients presenting with chronic rhinosinusitis (CRS). In all patients, Lund-Kennedy endoscopy scores, Lund-Mackay computed tomography scores, and Sino-Nasal Outcome Test-22(SNOT-22) scores were obtained before and after treatment with amoxicillin-clavulanic acid twice a day (625 mg) for 4 weeks. Patients were subsequently stratified into eCRS and non-eCRS groups based on having over 10 eosinophils per high-power field by histopathological examination. The efficacy of antibiotic therapy was compared between groups using the nonparametric Mann-Whitney U test. RESULTS: Within the non-eCRS group (n = 14), there was a significant improvement in both the Lund-Mackay score (P = .002) and SNOT-22 score (P < .001) but not the endoscopy score. Among the eCRS patients (n = 25), the Lund-Mackay score was similarly improved (P = .007); however, there was no significant improvement in the endoscopy or SNOT-22 scores. CONCLUSIONS: The use of antibiotics without independent anti-inflammatory properties have limited efficacy in patients with eCRS. The concept of maximal medical therapy using antibiotics must continue to evolve in the setting of new evidence for inflammatory subtypes of CRS. LEVEL OF EVIDENCE: 2b. Laryngoscope, 127:794-796, 2017.

Microarray analysis of the genes associated with osteitis in chronic rhinosinusitis.

OBJECTIVES/HYPOTHESIS: Although numerous studies have examined epithelial remodeling in chronic rhinosinusitis (CRS), bone remodeling (osteitis) has only recently gained attention as a potential significant contributor to the pathophysiology of recalcitrant CRS. The purpose of this study was to compare gene expression profiles between osteitic bone and the adjacent diseased mucosa in patients with CRS to determine which genes affect mucosal and bony remodeling. STUDY DESIGN: Prospective experimental analysis. METHODS: Samples were obtained from sites of osteitic bone and overlying mucosa in CRS patients demonstrating osteitis on computed tomography and compared to healthy controls. The entire transcripted gene expression profile was determined by microarray following RNA isolation and compared between tissue samples. The expression differences were verified by reverse transcriptase-polymerase chain reaction and immunohistochemical staining. RESULTS: Growth differentiation factor 5 and exostosin glycosyltransferase 1 were significantly upregulated and positively correlated with mucosal eosinophilic inflammation in osteitic bone. Fibroblast growth factor was significantly increased in osteitic bone. Additionally, colony stimulating factor was positively correlated with the degree of osteitis. CONCLUSIONS: These findings will add a new perspective to our current understanding of the recalcitrant CRS. LEVEL OF EVIDENCE: NA Laryngoscope, 127:E85-E90, 2017.

Inhibitory Effect of Pycnogenol® on Airway Inflammation in Ovalbumin-Induced Allergic Rhinitis.

BACKGROUND: The supplement Pycnogenol® (PYC) has been used for the treatment of several chronic diseases including allergic rhinitis (AR). However, the in vivo effects on allergic inflammation have not been identified to date. AIMS: To investigate the treatment results of PYC on allergic inflammation in a rat model of allergic rhinitis. STUDY DESIGN: Animal experimentation. METHODS: Allergic rhinitis was stimulated in 42 rats by intraperitoneal sensitization and intranasal challenge with Ovalbumin. The animals were divided into six subgroups: healthy controls, AR group, AR group treated with corticosteroid (dexamethasone 1 mg/kg; CS+AR), healthy rats group that were given only PYC of 10 mg/kg (PYC10), AR group treated with PYC of 3mg/kg (PYC3+AR), and AR group treated with PYC of 10 mg/kg (PYC10+AR). Interferon-γ (IFN-γ), interleukin-4 (IL-4), interleukin-10 (IL-10), and OVA-specific immunoglobulin E (Ig-E) levels of serum were measured. Histopathological changes in nasal mucosa and expression of tumor necrosis factor-α (TNF-α) and IL-1ß were evaluated. RESULTS: The levels of the IL-4 were significantly decreased in the PYC3+AR, PYC10+AR and CS+AR groups compared with the AR group (p=0.002, p<0.001, p=0.006). The production of the IFN-γ was significantly decreased in the PYC3+AR and PYC10+AR groups compared with the AR group (p=0.013, p=0.001). The administration of PYC to allergic rats suppressed the elevated IL-10 production, especially in the PYC3+AR group (p=0.006). Mucosal edema was significantly decreased respectively after treatment at dose 3 mg/kg and 10 mg/kg PYC (both, p<0.001). The mucosal expression of TNF-α has significantly decreased in the PYC3+AR and PYC10+AR groups (p=0.005, p<0.001), while the IL-1ß expression significantly decreased in the CS+AR, PYC3+AR, and PYC10+AR groups (p<0.001, p=0.003, p=0.001). CONCLUSION: PYC has multiple suppressive effects on allergic response. Thus, PYC may be used as a supplementary agent in allergic response.

Hemodynamic Effects of Topical Adrenaline During Septoplasty.

Vasoconstrictors agents is used in septal surgery, in attempt to improve haemostasis and thereby improve the surgical field. We aimed to compare the effect of lignocaine with adrenaline injection and alone lignocaine injection with topical adrenalin on perioperative hemodynamic effect, hemorrhage and postoperative pain. Patients undergoing surgery were randomised into two groups: group I in whom infiltration was performed with lignocaine (2 %) with adrenaline (1:100,000), group II in whom infiltration was performed with lignocaine (2 %) injection with topical adrenalin application (1:10,000). The two groups were matched by age, sex, body weight, pre-anesthesia blood pressure, heart rate, oxygen pressure and hemorrhage. The hemostatic effects postoperative pain in each group were analyzed. No statistically significant differences in operation time, hemodynamic effect, and intraoperative blood loss were reached between the two groups of patients (p > 0.05). But also group I had significantly better pain scores versus control group in the 2nd, 4th, 6th postoperative hours (p < 0.05). We suggest that the use of adrenaline infiltration during septal surgery is unnecessary and may subject the patient to the risk of cardiogenic side-effects of systemic absorption.

Awareness and daily practices of family physicians and trainees towards laryngopharyngeal reflux.

Laryngopharyngeal reflux (LPR) is a type of reflux, seen with complaints of hoarseness, chronic cough, and globus sensation, different from gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the awareness, knowledge, and practices of family physicians and trainees who were being trained in medical branches other than ENT and to determine the effective factors on decision making for diagnosis of this disorder. The study was designed as a two-stage study. At the first stage, a data collection tool, involving 29 questions by which the knowledge, awareness, and applications of the physicians about LPR would be determined, was developed with 12 specialists, using Delphi method. At the second stage, 101 family physicians replied the questionnaire online. For 45 trainees other than ENT, the questionnaire was filled face-to-face by one of the investigators. In patients admitted with complaints of hoarseness, lasting longer than 2 weeks, cough, lasting longer than 3 weeks, and globus sensation, the physicians considered LPR as the preliminary diagnosis with rates of 88.4, 82.2, and 62.8 %, respectively. 87.0 % of physicians, participating in the study, started treatment for reflux empirically in patients having complaints of hoarseness, chronic cough, and globus sensation; however, only 29.0 % of physicians prescribed this treatment for periods of 3 or 6 months. 69.9 % of physicians, participating in the study, made a diagnosis of reflux in general during their daily practices; only 6.9 % made the discrimination between LPR and GERD. Of all physicians, 27.9 % prescribed double-dose PPI or H2.

Protective effect of Pycnogenol on cisplatin-induced ototoxicity in rats.

CONTEXT: Pycnogenol®, which is French maritime pine bark extract, is a potent antioxidant. It is used in medical conditions caused by oxidative stress. Cisplatin (cis-diamminedichloroplatinum II) is an antineoplastic agent. However, its serious side effects such as ototoxicity limit its usage. OBJECTIVE: Antioxidants can be used to prevent ototoxicity. We investigated the effect of Pycnogenol® on cisplatin-induced ototoxicity. MATERIALS AND METHODS: Rats were randomly assigned to four groups of five. Distortion product-evoked otoacoustic emissions (DPOAE) test was performed for each rat. The experimental groups were as follows: Control Group, Pycnogenol® Group: 10 mg/kg Pycnogenol® intraperitoneally for 7 days, Cisplatin Group: intraperitoneally 15 mg/kg single injection of cisplatin on the fifth day, Cisplatin + Pycnogenol® Group: intraperitoneally 10 mg/kg Pycnogenol® treatment for 7 days, additionally on the fifth day, 15 mg/kg single injection of cisplatin was given. On the eighth day, DPOAE was re-performed and rats were sacrificed. Apoptosis was evaluated histopathologically. RESULTS: Mean percentage of apoptotic cells was 1.5, 3, 30 and 11% in organ of Corti and 2, 2, 40, 15% in spiral ganglion neurons in Control Group, Pycnogenol® Group, Cisplatin Group and Cisplatin + Pycnogenol® Group, respectively. Cisplatin Group and Cisplatin + Pycnogenol® Group were significantly different when compared to Control Group histopathologically both in organ of Corti and spiral ganglion neuron (p <0.001, p = 0.019, p = 0.001, p = 0.015). DPOAE results showed that Cisplatin + Pycnogenol® Group was significantly different when compared to Cisplatin Group at 3, 6 and 8 kHz (p < 0.05). CONCLUSION: Pycnogenol protected against cisplatin ototoxicity. Also, pycnogenol is not ototoxic.

[Laryngeal effect of experimental postnatal hypothyroidism: do thyroid hormone receptors change?]. / Deneysel postnatal hipotiroidinin larenkse etkisi: Tiroid hormon reseptörleri degisiyor mu?

OBJECTIVES: In this study, we aimed to investigate the laryngeal histopathological alterations and thyroid hormone receptors in rats with experimentally-induced postnatal hypothyroidism. MATERIALS AND METHODS: In this prospective, randomized study, pregnant Wistar albino rats were followed and newborn 20 Wistar albino rat pups were included in the study. The pups were randomly divided into two groups: In group 1 (methimazole (MMI)-induced hypothyroidism group), the mothers and pups were given MMI added water up to 90th day, as the pups were fed with breast milk for 19 to 22 days. In group 2 (control group), the mothers and pups were fed with MMI-free water up to 90th days. When the pups were 90 days of age, they were decapitated and their larynx was removed. Their larynx was evaluated for edema, inflammation, goblet cells, and thyroid hormone receptors (TR-α, TR-ß). RESULTS: Nine larynx samples for group 1 and eight for group 2 were studied. There was a significant difference in inflammation between the groups with slightly lower in the hypothyroidism group (p=0.009). The TR-α, TR-ß, and edema were significantly higher in the hypothyroidism group (p=0.002, p=0.029, p=0.029). There was no significant difference in the Goblet cells between the groups (p=0.637). CONCLUSION: Histopathologically increased laryngeal edema and increased thyroid hormone receptors were found, shedding light on the mechanism of voice changes in hypothyroidism.

Our Approach to Adult Patients With Epistaxis.

Epistaxis is one of the most frequently encountered emergency problems in our country, as it is throughout the world. In epistaxis, the benefits of implementing clinical guidelines are evident in both daily practice and medical education. In this article, the authors aimed to present their approach to adult patients with epistaxis and to share their experience, which considered the life quality of the patients to be at the forefront, based on some of their patients. In management of epistaxis, the implementation of the simplest method, minimally affecting the life quality of the patient, may be easier with a stepped approach. The authors consider that the stepped approach that they have implemented and presented in their study may lead to using less invasive methods and may accordingly improve the life quality of the patient.

Rarely Seen Nasal Congenital Problems Causing Neonatal Upper Respiratory Obstruction: A Case Series.

Since newborns are obligatory nasal breathers, upper respiratory tract problems may sometimes be life threatening. The most common pathology causing dyspnea and stridor in newborns is laryngomalacia. Nasal cavity pathologies that risk the neonatal airway are more rarely met. These anomalies may be seen either as solitary anomalies or as a part of a syndrome. While choanal atresia is one of the best-known nasal cavity anomalies, choanal stenosis, congenital nasal mid-line masses, congenital nasal pyriform aperture stenosis, and nasal tip anomalies are more rarely seen structural pathologies. Choanal atresia may be present either as an isolated congenital anomaly or as a part of CHARGE syndrome. Some rare chromosome anomalies may also cause significant problems during nasal respiration in newborns. With this study, we presented a case series of newborns with pathologies that affected nasal respiration. Although the diagnosis and treatment of choanal atresia and congenital dacryocystocele are well known, the information on the diagnosis and treatment of the other two uncommon cases are limited. With this study, we aimed to contribute to the literature by presenting our approach in six cases having congenital pathologies that cause nasal respiratory obstruction.

Can tissue adhesives and platelet-rich plasma prevent pharyngocutaneous fistula formation?

OBJECTIVE: One of the frequently encountered disorders of wound healing following laryngectomy is pharyngocutaneous fistula. However, although studies have been performed with the aim of prevention of pharyngocutaneous fistulae, there are very few studies with tissue adhesives and platelet-rich plasma. In this study, our aim was to investigate the histopathologic changes in wound healing caused by various tissue adhesives and platelet-rich plasma, together with their effects on prevention of pharyngocutaneous fistula. METHODS: 40 male rats were randomly divided into five groups: control, platelet-rich plasma, fibrin tissue adhesive, protein-based albumin glutaraldehyde and synthetic tissue adhesive groups. The pharyngotomy procedure was performed and was sutured. Except the control group, tissue adhesives and platelet-rich plasma were applied. Then, the skin was sutured. On the seventh day, the rats were sacrificed. The skin was opened and pharyngotomy site was assessed in terms of fistulae. The pharyngeal suture line was evaluated histopathologically by using Ehrlich Hunt scale. RESULTS: Inflammatory infiltration was found to be higher in "platelet-rich plasma" group than "fibrin tissue adhesive" and "synthetic tissue adhesive" groups. The fibroblastic activity of "platelet-rich plasma", "fibrin tissue adhesive" and "protein-based albumin glutaraldehyde" groups was higher than the control group. The positive changes created by platelet-rich plasma and fibrin tissue adhesive at the histopathologic level were found together with no detected fistula. Among the study groups, there was no statistical difference for pharyngeal fistula development. This result may be obtained by the small number of animal experiments. CONCLUSION: These results shed light on the suggestion that platelet-rich plasma and fibrin tissue adhesive can be used in clinical studies to prevent pharyngocutaneous fistula.

Successful Treatment of Essential Palatal Tremor Lasting Over a Long Term with a Rare Application of Botulinum Toxin in a Child.

Objective Essential Palatal Tremor (PT) is a disorder in which radiological brain images appear normal but the clicking noise caused by peritubal, palatal muscle contractions remains the main complaint of patients. The condition occurs rarely in childhood. This paper demonstrates such a rare case with bilateral presentation of essential PT in a 12-yr-old girl could successfully be treated with botulinum toxin therapy at Otorhinolaryngology Department in 2013, as she was still asymptomatic after 16 months. Besides, being minimally invasive with negligible side effects, this choice of treatment with botulinum toxin A (BTA) leads to a long-term symptom free outcome from essential PT.

Effects of adenoidectomy/adenotonsillectomy on ADHD symptoms and behavioral problems in children.

OBJECTIVES: In children, the most common reason of upper airway obstruction (UAO) is adenotonsillar hypertrophy. In literature, the adverse effects of UAO and obstructive sleep apnea syndrome on behavior and attention in children have been reported in several articles. However, the methods used for the evaluation of behavioral disorders have not been standardized in those studies. The aim of this study was to investigate the behavioral and attention characteristics of children before and after adenoidectomy/adenotonsillectomy using an internationally valid method. METHODS: A total of 41 patients, between 6 and 11 years of age and having a medical history of UAO for at least one year for which adenotonsillectomy procedure was indicated, were enrolled in the study. The patients were evaluated for signs of attention/behavioral disorders by a child-adolescent psychiatrist and Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version (K-SADS-PL) and The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S), before and at the 6th month following the operation. RESULTS: In the preoperative period, a psychiatric disorder was identified by K-SADS-PL in 41.4% (n =1 7) of patients. Of these, 11 patients had attention deficit hyperactivity disorder (ADHD), 6 had enuresis nocturna, and 2 had separation anxiety disorder. Pre- and postoperative mean scores in T-DSM-IV-S parent scale were 31.3 ± 8.5 and 20.2 ± 10.3, respectively, and this difference was statistically significant (p < 0.001). CONCLUSION: The relationship of UAO and attention/behavioral disorders should be taken into consideration by child-adolescent psychiatrists together with ENT specialists and a multidisciplinary approach is important for the treatment team.

Acinic cell carcinoma of the posterior wall of the pharynx.

Acinic cell carcinoma accounts for approximately 2 to 6% of all salivary gland tumors. It usually originates in the parotid gland; the minor salivary glands and the upper respiratory tract are involved only infrequently. We describe a case of acinic cell carcinoma of the posterior wall of the pharynx in a 21-year-old woman. To the best of our knowledge, this is the first case of this type of carcinoma at this location to be published in the literature. The mass was excised, and the patient was referred for postoperative radiation therapy to reduce the risk of local recurrence, but she did not keep her appointment and was lost to follow-up.

Detection of the Epstein-Barr virus, Human Bocavirus and novel KI and KU polyomaviruses in adenotonsillar tissues.

OBJECTIVES: We aimed to investigate the seasonal disturbations and the rates of detection of Epstein-Barr virus (EBV), Human Bocavirus (HBoV), and polyomaviruses KI and WU (KIPyV and WUPyV) in adenoid and tonsil tissues during the absence of acute infection symptoms. STUDY DESIGN: Cross-sectional prospective study. SETTING: Tertiary hospital. METHODS: DNA expressions of EBV, HBoV, polyomaviruses KIPyV and WUPyV were investigated in children with chronic tonsillar and adenoidal diseases using real-time polymerase chain reaction. The patients were grouped as follows: adenoid, recurrent tonsillitis and hypertrophic tonsillitis group. The relationships of the expressions of these viruses with age, gender, recurrent infection and airway obstruction were also analyzed. Seasonal variations in rates of detection of these viruses in adenoid and tonsil tissues were also investigated. RESULTS: Considering adenoid specimens, HBoV was found to be the most frequent virus with the rate of 43.1%. In specimens of recurrent tonsillitis and hypertrophic tonsils, EBV was the most frequently encountered virus (53.8%, and 32.0%, respectively). In children with hypertrophic adenoids, while HBoV was detected to be positive throughout the year, EBV was present throughout the year in children with recurrent tonsillitis. CONCLUSIONS: The detection of HBoV and EBV throughout the year in samples of children with asymptomatic chronic adenotonsillar diseases may indicate that these viruses may remain persistently in lymphoepithelial tissues of upper respiratory tract. Virus persistence may have a pathogenetic potential for development of lymphoid hypertrophy and a chronic stimulatory effect for inflammation.

Evaluation of Lapatinib and Trastuzumab for Ototoxic Effects.

OBJECTIVE: Trastuzumab and lapatinib are widely used chemotherapeutic agents. Our aim in this study was to assess the possible ototoxicity of these chemotherapeutic agents. MATERIALS AND METHODS: Forty-eight rats were divided into six groups: Group 1 (control, n=8) received intraperitoneal saline for 7 days. Group 2 (n=8) and Group 3 (n=8) received 10 mg/kg and 30 mg/kg single doses of intraperitoneal trastuzumab, respectively. Lapatinib was administered by oral gavage to Group 4 (n=8) at 100 mg/kg/day and to group 5 (n=8) at 300 mg/kg/day for 7 days. Group 6 (n=8) received only one dose of 10 mg/kg intraperitoneal trastuzumab; subsequently, Group 6 received one dose of lapatinib at 100 mg/kg/day by oral gavage for 7 days. Before any medication was administered, distortion product emissions (DPOAE) were obtained. DPOAE tests were performed again on the rats on day 7, after which the mastoid bullas were harvested. The apoptosis degree was evaluated by the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) procedure. RESULTS: The lapatinib 300 and lapatinib+trastuzumab groups (p=0.008 and p=0.001, respectively) were significantly different from the control group according to the spiral ganglion TUNEL. Apoptosis in the organ of corti was statistically different compared with the control group in the lapatinib 100, lapatinib 300, and lapatinib+trastuzumab groups (p=0.035, p=0.001, and p<0.001, respectively). Trastuzumab induced damage in only the organ of corti; however, lapatinib induced damage in both the organ of corti and spiral ganglion. The degree of the damage in the organ of corti was high when trastuzumab and lapatinib were concomitantly used. Supporting this data, a reduction in DPOAE amplitudes was observed during the combined usage of the drugs. CONCLUSION: Administering trastuzumab and lapatinib causes ototoxic effects.

The Effects of Topical Burow's and Castellani's Solutions on the Middle Ear Mucosa of Rats.

OBJECTIVE: The aim of this study is to investigate the early histopathologic effects of Burow's and Castellani's solutions on the middle ear mucosa of rats. MATERIALS AND METHODS: The study was conducted with 26 Wistar albino female rats. Gelfoam that was soaked in 4% Burow's solution was inserted into the middle ears of the rats in the Burow group (n=10); over 2 weeks, 0.1 mL Burow's solution was administered once a day through perforation into the middle ear. The same procedure was applied to the rats in the Castellani group (n=10) using classical Castellani's solution and to the rats in the control group (n=6) using physiological saline solution. At day 1 after the last administration, all groups were decapitated; their bullas were dissected. The bullas were histopathologically evaluated and graded with respect to increase in leukocytes with polymorphic nuclei, mononuclear cell infiltration, and fibrosis. The data obtained were statistically analyzed. RESULTS: In the Burow group, the fibrosis scores were significantly higher than those in the control group (p=0.039), the scores of leukocytes with polymorphic nuclei were significantly higher than those in the control group (p=0.034), and the total scores were significantly higher than those in the control group (p=0.022). CONCLUSION: We suggest Castellani's solution as a safe alternative in the treatment of otomycosis and external otitis in the presence of tympanic membrane perforation. However, because of the inflammatory changes it causes in the middle ear mucosa, we do not recommend the use of Burow's solution in the presence of tympanic membrane perforation.