Improvement of hearing results by bone cement fixation in endoscopic stapedotomy.

OBJECTIVE: This study aimed to compare the hearing results of two different stapedotomy techniques used in the clinic at different time points. METHODS: An endoscopic surgery group (group 1; n = 37) were compared retrospectively with a microscopic surgery group (group 2; n = 57). A small fenestra and Teflon piston technique were used in all patients. Bone cement was used for fixation between the prosthesis and incus in the endoscopic group only. Bone conduction threshold and air-bone gap were used as the comparison parameters. RESULTS: The pre-operative air-bone gap was 31.26 dB in group 1 and 32.51 dB in group 2. The post-operative air-bone gap was 8.93 dB in group 1 and 14.28 dB in group 2. There was a significant difference between the groups in post-operative air-bone gaps. There was no significant difference between the groups in post-operative bone conduction thresholds. CONCLUSION: The endoscopic technique using bone cement fixation was better for closing the air-bone gap.

Does rigid bronchoscopy induce bacterial translocation? An experimental study in rats.

BACKGROUND: Although some reports suggest that bronchoscopy induces bacterial translocation (BT), the mechanisms of BT remain unclear. OBJECTIVE: We aimed to assess whether bronchoscopy or hypoxemia during bronchoscopy is responsible for BT. METHODS: We evaluated 24 rats divided into three subgroups: the control group (group 1, n = 8); the rigid bronchoscopy group (group 2, n = 8), and the group receiving bronchoscopy + mechanical ventilation (group 3, n = 8). Oxygen saturation (SaO(2)) was measured during the bronchoscopic procedure. Blood and tissue cultures from mesenteric lymph nodes (MLNs), liver, spleen and cecal contents were obtained 24 h following bronchoscopy. RESULTS: In group 2, SaO(2) was significantly lower than in groups 1 and 3 (p < 0.01). In group 2, BT significantly increased (6/8, 75%; p < 0.01 vs. group 1, and p < 0.05 vs. group 3). The main site of translocation was MLNs (6/8, 75%) in group 2, while BT was detected in only 1 rat in group 3 (1/8, 12.5%). CONCLUSION: Hypoxemia during rigid bronchoscopy resulted in intestinal mucosal damage in a rat model. Hypoxemia may have been the trigger for BT from the intestine following bronchoscopy.

Subconjunctival ecchymosis due to rhinoplasty.

Orbital complications of rhinoplasty show a wide range from minor complications like periorbital edema and ecchymosis to severe complications like blindness. Also, subconjunctival ecchymosis is one of the orbital complications due to rhinoplasty. A prospective study was set out to assess the incidence and progression of subconjunctival ecchymosis and to find out mechanisms of this complication. The incidence of subconjunctival ecchymosis was found to be 19.1%. Typically it appeared unilaterally or bilaterally over the temporal subconjunctival area in the first two days after the operation. Complete resolution of subconjunctival ecchymosis took approximately 11 +/- 3 days. No other ocular symptoms were found. Subconjunctival ecchymosis only prolonged the recovery period of the patient from the rhinoplasty.

The effect of trimetazidine on the survival of rat island skin flaps subjected to ischemia-reperfusion injury.

The effect of trimetazidine (TMZ) on flap ischemia-reperfusion injury was investigated in rat inferior epigastric artery flaps. Twenty-six rats, divided into four experimental groups-nonischemic group (group 1, N = 5), ischemic control group (group 2, N = 7), preischemic TMZ-treated group (group 3, N = 7), and postischemic TMZ-treated group (group 4, N = 7)-were used. Rat inferior epigastric artery flaps were rendered ischemic by occluding the feeding femoral artery, and they were reperfused by releasing the clamps after 11 hours in groups 2 through 4. Group 3 rats were given TMZ (3 mg per kilogram, intravenously) diluted in saline before application of the clamp, and group 4 rats were given TMZ before clamp removal. Flap survival was scored on postoperative day 8. All flaps in the nonischemic control group (group 1) survived completely. The ischemic control group (group 2) demonstrated a 6.3 +/- 4.3% survival area. In the preischemic TMZ group (group 3) the mean survival area was 76.9 +/- 6.1%, and in the postischemic TMZ group (group 4) it was 76.8 +/- 5.6%. TMZ-treated flaps showed a significant increase in survival area regardless of the time of administration (p = 0.001, group 3 vs. group 2; p = 0.001, group 4 vs. group 2). This finding suggests that TMZ has a beneficial effect on the prevention or treatment of arterial ischemic flaps.

Cardiovascular safety of cocaine anaesthesia in the presence of adrenaline during septal surgery.

OBJECTIVE: The purpose of this study was to investigate the possible cardiovascular side effects of 4% cocaine solution in the presence of adrenaline during septal surgery. METHOD: Sixty adult patients undergoing elective septal surgery with local anaesthesia were included in the study. Noses were packed with 5-mL 4% cocaine (200-mg) solution on cotton pledgets, which were left in the nose for 15 minutes. Then, 10 mL of local anaesthetic (lidocaine 2% and adrenaline 1:100,000) were infiltrated in septal mucosa, and 15 minutes later, the surgical procedure was initiated. At the beginning of the operation, intervals from 12-lead surface electrocardiograms and vital signs including blood pressures and heart rate were recorded as a baseline. All measurements were repeated just before local anaesthetic infiltration, just before the beginning of the surgical procedure, and, finally, at the end of the operation. All four measurements and electrocardiographic tracings were examined. Systolic and diastolic blood pressures and QT parameters, RR intervals, and heart rates obtained from electrocardiogram were compared statistically with repeated-measures analysis of variance. RESULTS: No statistically significant difference was found among all four staged measurements. None of the patients developed tachycardia, hypertension, hypotension, or any chest pain. In electrocardiogram tracings, no sinus tachycardia depression, elevation, or bundle branch block was noted. CONCLUSION: This study shows that concomitant use of cocaine and adrenaline in the proper concentration and volume and in a carefully screened patient group was safe for the cardiovascular system.

Effects of single-dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty.

To examine the effects of single-dose dexamethasone use on edema, ecchymosis, and intraoperative bleeding in rhinoplasty, a double-blind, randomized trial with placebo control was planned. A total of 55 consecutive patients were included in the study. The dexamethasone (10 mg) was given intravenously just before surgery (preoperative group, n=18) or at the end of surgery (postoperative group, n=20). In the placebo group, 17 patients received saline preoperatively or postoperatively. Intraoperative blood loss was recorded for each patient. Postoperative scoring of eyelid swelling and ecchymosis was begun after approximately 24 hours and lasted into postoperative day 9. Only for the first 2 days was the difference between steroid groups (preoperative and postoperative) and the placebo group statistically significant for a decrease in eyelid edema (p < 0.05). A statistically significant difference in upper eyelid ecchymosis for both preoperative and postoperative steroid groups versus the placebo group also existed in the first 2 days (p < 0.05). Preoperative or postoperative steroid administration had no influence on the ecchymosis of the lower eyelid. When the results of the preoperative and postoperative steroid groups were compared, no significant difference was detected between the two groups in either edema or ecchymosis. To determine whether steroid use shortened the recovery period, the days on which edema and ecchymosis reached a minimum level were compared among the groups; no statistically significant difference was found among them. Using single-dose dexamethasone preoperatively did not alter intraoperative blood loss. Use of single-dose dexamethasone (either preoperatively or postoperatively) in rhinoplasty has a significant effect in decreasing upper and lower eyelid edema and upper eyelid ecchymosis for the first 2 days when compared with a placebo group. However, the effect of dexamethasone was lost after the first 2 days, and its use did not shorten the recovery period.

High-frequency hearing and reflex latency in patients with pigment disorder.

PURPOSE: To investigate the activities of inner ear melanin in patients with pigment variations and disorders. Our purpose was to find evidence on the effects of melanin-containing cells by measuring the high-frequency threshold and the latency of stapes reflex in patients with vitiligo. PATIENTS AND METHODS: Twenty-nine patients with active vitiligo and 41 healthy subjects were included in this study. Pure tone thresholds were determined at frequencies between 250 and 16,000 Hz. Ipsilateral and contralateral stapes reflexes were measured at 1,000, 2,000, and 4,000 Hz. After we compared the results in the control and vitiligo groups by using the Mann-Whitney U test for each frequency, we compared women and men separately to eliminate gender differences. RESULTS: Pure tone thresholds of the vitiligo group were significantly lower than the control group at 4,000, 6,000, 8,000 and 10,000 Hz (P < .05). The statistically different thresholds were 8,000 and 10,000 Hz in women, compared with 4,000, 6,000, 8,000, 10,000, 12,500, and 16,000 Hz in men (P < 0.05). Reflex latencies for the two groups were not statistically different. CONCLUSION: Vitiligo, which is a type of pigment disorder, seems to be an effective factor in hearing loss, and men are more susceptible to it than women. The mechanism for this condition might be the absence of the preventive function of melanin-containing cells in the inner ear.

Comparison of amoxicillin with second and third generation cephalosporins in the treatment of acute otitis media.

The aim of the present study was to compare the efficacy and the tolerability of three different antibiotic regimens for the treatment of acute otitis media in paediatric patients. 75 children, age range 6 months-6 years, divided into three groups, were involved in the study, each group consisting of 25 randomly assigned children (Group 1, amoxicillin 40 mg/kg tid per os for 10 days; Group 2, cefuroxime axetil 30 mg/kg bid per os for 10 days; ceftriaxone 50 mg/kg single-dose i.m.). No statistically significant difference was noted in the clinical efficacy among the different groups. Although amoxicillin is the drug of choice in paediatric otitis media, single dose ceftriaxone might be considered as an interesting alternative regimen when ease of administration and cost of therapy are considered.

Importance of mastoid pneumatization on secretory otitis media.

Secretory otitis media is the most common middle ear disease of childhood. It heals spontaneously, by medical therapy or by minor surgical procedures in most of the cases. Sequelae such as retraction pockets and adhesive otitis that lead to cholesteatoma rarely occur, but initially it is hard to diagnose which patient will acquire a sequela. It is well known that mastoid pneumatization is poor in the patients who had complications like retraction pocket, adhesive otitis and cholesterol granuloma. The aim of this study was to determine if any relationship exists between mastoid pneumatization and secretory otitis media. Lateral mastoid X-rays of 47 children with secretory otitis media were evaluated. After 2 months of follow-up with medical therapy, 30 of the 47 patients needed ventilation tube insertion. The remaining 17 patients showed total recovery with medicines only. Control X-rays of the operated patients were taken 6 months after the operation. Mastoid pneumatizations of patients healed with medicine were compared with the operated patients. There were statistically significant differences between the mastoid pneumatizations of surgically and medically treated groups. In addition we observed a statistically significant difference between the mastoid areas of the preoperative and the postoperative X-rays. We concluded that mastoid pneumatization might be considered as a prognostic indicator in secretory otitis media. The estimated prognosis is poor when the mastoid pneumatization is poor.

The use of molded tympanic heterograft (lamb peritoneum).

The molded heterograft tympanic membrane was applied to twenty-five ears during tympanoplasty. The advantages and disadvantages of the graft material are discussed. Although autograft use is the principal choice, we strongly believe that this heterograft technique may be an alternative for tympanic membrane grafting; especially in revision cases in which temporalis fascia has already been used.