Comparison of autogeneous and homogeneous nasal dorsal onlay grafts in an experimental design.

An experimental model was used for the comparative evaluation of autogeneous and homogeneous nasal dorsal onlay cartilage grafts. This study was conducted on 18 adult white New Zealand male rabbits. Nasal septal cartilage (NSC), sliced nasal septal cartilage (SNSC) and auricular cartilage (AC) grafts were prepared in autogeneous and homogeneous forms and placed into the subcutaneous pockets of the nasal dorsum of rabbits. After a period of 3 months, the animals were painlessly killed, and each site was analyzed histologically for inflammation, neovascularization, fibrosis and resorption. Inflammation, fibrosis and neovascularization were found to be significantly more extensive in the homogeneous graft groups and autogeneous SNSC group 3 months after implantation. Resorption was significantly high in both homogeneous and autogeneous AC groups and significantly low in the autogeneous and homogeneous SNSC groups. There was no significant difference between the homogeneous and autogeneous grafts in terms of resorption rates. In conclusion, the results of this experimental study demonstrate that resorption was lesser than expected in the sliced cartilage graft and that homologous cartilage graft applications had activity and reliability similar to that of autogenous cartilage grafts.

Accuracy of Internet guidance on pediatric otolaryngology procedures.

OBJECTIVES: To evaluate the reliability and accuracy of the most visited Internet websites for the frequently performed surgical pediatric otorhinolaryngology procedures. STUDY: A google.com search was used to determine the top 20 Internet sites for the terms 'adenoidectomy', 'tonsillectomy' and 'ventilation tube surgery'. The DISCERN plus questionnaire was used to score each website. Furthermore, a 'hit list' of reliable and accurate websites was created depending on the most clicked healthcare organizations with corporate identities and the personal websites of the otolaryngologists with academic titles who were members of the Turkish Society of Otolaryngology Head and Neck Surgery. The pages were also investigated as if they were in this list of accurate websites. RESULTS: Of the 60 websites viewed for the terms 'adenoidectomy', 'tonsillectomy' and 'ventilation tube surgery', only 23.3% were matching the list of accurate websites. The mean DISCERN plus score was 35.70 (16-58), 38.02 (16-80) and 39.08 (16-58) for adenoidectomy, tonsillectomy and ventilation tube surgery respectively. There was no significant difference between the three groups (p>0.05). The mean DISCERN plus score for all the websites was 37.37 out of the maximum score of 80. CONCLUSIONS: In the light of our results we can conclude that the quality of data on the Internet is not adequate enough to obtain information about the most frequent surgical procedures in pediatric otorhinolaryngology. Clinicians must be aware about this fact and warn the parents about the disinformation which may lead to wrong decisions.

Audiologic evaluation in pediatric patients with type 1 diabetes mellitus.

OBJECTIVE: The aim of this study was to perform audiological evaluation of children with type 1 diabetes mellitus (DM). METHODS: One hundred DM patients (200 ears) were included in the study. Pure-tone audiometry at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz; immittance measures including tympanometry and acoustic reflex testing; transient evoked otoacoustic emission (TEOAE); and auditory brainstem response (ABR) testing were performed in the patients. The results were statistically compared with metabolic control of DM, positive and negative autoantibodies, duration of DM, and present concomitant Hashimoto and celiac diseases. RESULTS: The proportion with a result of 'fail' for the TEOAE test in the DM patients was not statistically significant among all groups (p > 0.05). The autoantibodies, blood glucose level, and present concomitant Hashimoto and celiac diseases were not associated with prolonged ABR latencies. However, ABR peripheral transmission time (wave I) was significantly delayed with the increasing duration of DM (p < 0.05). CONCLUSION: Pediatric patients with type 1 DM do not frequently present with cochleovestibular symptoms, but show higher audiometric thresholds and the absence of or reduction in TEOAE amplitudes. In ABR testing, the increase in the peripheral transmission time (wave I) is more suggestive of retrocochlear alterations in pediatric cases of type 1 DM compared with conventional audiometric tests (e.g., pure-tone audiometry and OAEs), which may indicate possible initial auditory neuropathy. Further longitudinal investigations on a wide range of control and pediatric subjects with DM will be necessary to confirm the present data and to detect initial auditory neuropathy.

Obstructive sleep apnea syndrome (OSAS) and social support in elder patients.

Social support is a very important aspect in debilitating diseases. OSAS is a disabling disease that impairs social functioning and accounts for a large socio-economic burden for the community. In this study our aim is to investigate social support levels among OSAS patients: 85 of them with the diagnosis of OSAS were enrolled in the study. Multidimensional scale of perceived social support (MSPSS) is used to measure the perception of individuals' social support sufficiency. In contrast to many studies, we found that social support levels of elder patients were higher than the young ones and family subscale was significantly higher. It might be both due to Turkish family structure that the grands are in close relationship with the other family members and the adverse effects of the disease which have more negative impact on young patients' life. In conclusion, social support is an important aspect in OSAS patients. The interventions for the enhancement of social support could lead to substantial cost-savings, reduce morbidity, and increase well-being.

Comparison of minimally invasive techniques in tongue base surgery in patients with obstructive sleep apnea.

OBJECTIVE: To compare the effectiveness and morbidity of 3 microinvasive tongue base surgical procedures combined with uvulopalatopharyngoplasty (UPPP) in supine-dependent obstructive sleep apnea (OSA) patients. STUDY DESIGN: A prospective, randomized clinical study. SETTING: A tertiary referral center. METHODS: Fifty OSA patients were randomly advised to undergo UPPP combined with low-temperature bipolar radiofrequency (group 1), submucosal minimally invasive lingual excision with radiofrequency (SMILE-R; group 2), or submucosal minimally invasive lingual excision with a harmonic scalpel (SMILE-H; group 3). The Epworth Sleepiness Scale, the visual analog scale (VAS) for snoring, the pre- and postoperative 3-month polysomnography (PSG) findings, and the decrease in tongue volume using magnetic resonance imaging (MRI) were compared. The operation times, the postoperative pain VAS score, the analgesic requirement, and the time in commencing a normal diet were compared in the 3 groups. RESULTS: The decrease in apnea-hypopnea index (AHI) and supine AHI values at the postoperative 3-month time point was significant in group 2 (P < .05). The decrease in tongue volume at the 3-month postoperative time point according to the MRI evaluations was higher in groups 1 and 2 (P < .05). In the subjective comparison of effectiveness, there was no significant difference. The operation time was significantly lower in group 3. In the assessment of postoperative pain, no significant difference was found between the groups. CONCLUSION: When the PSG findings and MRI were evaluated, UPPP + SMILE-R were found to be more effective. No significant difference was found between the 3 techniques when morbidity and complications were compared.

The effect of oral isotretinoin (13-cis retinoic acid) on hearing systems in patients with acne vulgaris: a prospective study.

Isotretinoin is widely used in the treatment of extensive and nodulocystic acne. The objective of this prospective study was to investigate whether oral isotretinoin could affect the hearing system. Thirty-eight patients with acne vulgaris (76 ears) who were diagnosed and treated at the Department of Dermatology were included in the current study. Study evaluation visits were performed at baseline and at Weeks 1, 2 and 3. Pure-tone averages (PTAs) of air conduction thresholds at 250 Hz (PTA1); 500, 1000, and 2000 Hz (PTA2); 4000, 8000, and 10,000 Hz (PTA3); and 12,500, 16,000, 18,000 and 20,000 Hz (PTA4) for each ear were calculated separately. Assessment of the efficacy was based on the audiometric findings. Compared with pre-treatment evaluation, the PTAs of patients were found to be significantly different at the first week for PTA2 (P = 0.033) and PTA3 (P = 0.001), at the second week for PTA1 (P = 0.036), and at the third week for PTA4 (P = 0.002). Our results suggest that the oral isotretinoin (13-cis retinoic acid), which is a derivative of retinol (vitamin A), improved the hearing level of the patients in all audiometric frequencies in a short-period follow-up.

Evaluation of contact sensitivity in patients with isolated itching of the external auditory canal.

OBJECTIVE: This study was designed to demonstrate the frequency of sensitivity to European standard patch test allergens in patients with isolated itching of the external auditory canal (EAC). STUDY DESIGN: A prospective case-control study. METHODS: Fifty-six female patients with the complaint of recurrent EAC itching and 30 female controls without pruritis of the ears were patch-tested with 25 allergens of the European standard series. RESULTS: Twenty-four patients (25.5%) had one or more positive patch test reactions. In 21.4% of patients, nickel sulphate was the most frequent sensitizer, but there was no statistically significant difference in the nickel sensitization rate between patients and controls (p > .05). Sensitivity rates were much lower for the other allergens. There was no association between contact sensitivity to fragrances and to preservatives and patients with pruritis of the ears. CONCLUSION: Our results do not demonstrate that most patients with pruritic ears probably suffer from allergic contact dermatitis.

Investigation of hearing in patients with allergic rhinitis.

The aim of the current study is to investigate hearing function in patients with allergic rhinitis. Fifty-eight patients with positive skin prick test (Group 1) (116 ears) and 31 subjects with negative skin prick test (62 ears) as group 2 were included. Pure tone audiometry at 250, 500, 1000, 2000, 4000 and 8000 Hz and immittance measures, including tympanometry and acoustic reflex tests, were performed in both groups. There was statistically significant difference between pure-tone threshold of the group 1 and group 2 at 8000 Hz (p< 0.05). Based on our study, the patients with allergic rhinitis had better hearing than the control group at 8000 Hz.

[Comparison of the cephalometric posterior airway analysis with endoscopic tongue base hypertrophy findings in patients with obstructive sleep apnea syndrome]. / Obstrüktif uyku apne sendromlu hastalarda sefalometrik posteriyor hava yolu analizi ile endoskopik dil kökü hipertrofi bulgularinin karsilastirilmasi

OBJECTIVES: This study aims to identify the contribution of the cephalometric investigation in the soft tissue evaluation in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: The clininical data of 300 patients (191 males, 109 females; mean age 48.3±9.9 years; range 24 to 76 years) diagnosed with OSAS in our clinic between January 2009 and May 2010 were retrospectively evaluated. All subjects in the test group had overnight polysomnography, cephalometry and flexible endoscopic examination. Distance and angle calculations were performed with the previously determined landmarks on cephalograms. The degrees of tongue base hypertrophy were recorded in the flexible endoscopic examinations. Posterior airway space calculations were compared with tongue base hypertrophy findings by using chi-square analysis. RESULTS: The mean apnea hypopnea index (AHI) score and the mean supine AHI were calculated to be 24.7 and 26.5, respectively. According to the endoscopic examination, the tongue base hypertrophy was grade 0 in 20 patients (6.6%), grade 1 in 60 patients (20%), grade 2 in 122 (40.6%) patients and grade 3 in 98 (32.6%) patients. The posterior airway space value calculated to be 4 mm at minimum and 15 mm at maximum. When the cephalometric measurements of the patients were compared with the magnitude of tongue base hypertrophy detected by endoscopic examination, it was determined that the relationship with the size of the tongue base decreases as the posterior airway space increases. CONCLUSION: Cephalometric investigation, which is known as adjunct technique in the soft tissue evaluation, does not provide adequate information in the evaluation of the OSAS patients.

Allergic rhinitis (AR) in geriatric patients.

Allergic rhinitis (AR) can be defined as an inflammatory disease of the nose and the paranasal sinuses, characterized by a specific IgE-mediated hypersensitivity reaction. The aim of this study was to evaluate the correlation between the symptoms of AR and the prick test results in geriatric patients presenting with symptoms of AR by comparing these with those of a young control group. Thirty-two geriatric patients (Group 1) were analyzed retrospectively, and 37 patients (Group 2) were selected as the control group. Diagnosis of AR was made based upon the physical examination findings, nasal endoscopic examination findings and the skin prick test results. While the skin prick test positivity was 50% in Group 1, this rate was found as 75.7% in Group 2. The difference was found to be statistically significant (p=0.044). A statistically significant difference was found between the two groups in terms of susceptibility to mugwort pollen and fish (p=0.048, p=0.033). In conclusion, in geriatric patients presenting with AR symptoms, systemic treatment should not be initiated before performing skin prick test, due to the adverse effects of the drugs.

Effects of hearing aids on cognitive functions and depressive signs in elderly people.

With the physical, emotional and cognitive effects of senility, elderly people, especially those with impaired hearing, need rehabilitation for improving their life conditions. Hearing aids are frequently used to improve their daily life communications and activities. The aim of this study was to report the cognitive and psychological benefits of using hearing aids by the elderly people, over the age of 65. This was a prospective, single-arm interventional study in 34 elderly subjects with hearing impairment who answered the geriatric depression scale-short form (GDS) questionnaire and the mini mental state examination (MMSE) test, prior to, and 3 months following the use of hearing aid, after obtaining the patients' consent to participate in study. Patients with evidence of focal neurological loss with clinical examination, a confusional state, sudden hear loss and severe tinnitus were not included in the study. Scores of the effects of hearing aids on mood and cognitive functions were compared for each subject, before and after, and between males and females. After 3 months of using a hearing aid, all patients showed a significant improvement of the psychosocial and cognitive conditions, and all of them showed betterment of their problems, i.e., the social communication and exchanging information. In conclusion, for the elderly people with the effects of hearing aids in presbycusis and due to the significant improvement in psychological state and mental functions, using and being adaptable to hearing aids is a good solution.

Utilization and dissection for endoscopic sinus surgery training in the residency program.

OBJECTIVE: To develop an animal cadaver model that would allow residents to learn functional endoscopic sinus surgery as a complementary model. STUDY DESIGN: Prospective experimental study. PATIENTS AND METHODS: Two of our first-year residents were included in the study, and each operated on 5 sheep noses. All the routine steps of endoscopic sinus surgery were performed, except for sphenoidotomy, and their success and complication scores were recorded. The residents' performance for maxillary antrostomy, ethmoidectomy, and frontal sinusotomy in sheep cadaver noses were evaluated by the authors. Predissection and postdissection computer tomography assessed the completeness of dissection. Images were analyzed for maxillary antrostomy, frontal sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. The first and last 5 sides of residents were analyzed together as the first 10 sides (group 1) and last 10 sides (group 2). RESULTS: Group 2 had significantly better outcomes for frontal sinusotomy and ethmoidectomy (P = 0.011 and P = 0.003, respectively). The mean duration of procedures for group 1 was 15.7 minutes and that for group 2 was 10.3 minutes (P = 0.000). The difference was not significant between the 2 groups when comparing the success rates of maxillary antrostomy and the complication rates (P > 0.05). CONCLUSIONS: The nasal cavity of the sheep is anatomically similar to the human nasal cavity, and the model using sheep cadaver for endoscopic sinus surgery training is a cost-effective and useful model for the first step of the learning curve.

Hashimoto thyroiditis and thyroid gland anomalies.

There are several thyroid gland developmental anomalies such as presence of a pyramidal lobe, absence of the lateral lobes, absence of the isthmus or incomplete isthmus, and significantly asymmetric lateral lobes. The absence or agenesis of the isthmus is a rare condition (1%). In this report, we present a case with Hashimoto thyroiditis and thyroid gland anomalies that consist of thyroglossal duct remnant and absence of the isthmus. Furthermore, an anomaly in the parathyroid gland location and morphologic anomaly as a cystic parathyroid gland were seen in our case.

Anomalous relationship of the retromandibular vein to the facial nerve as a potential risk factor for facial nerve injury during parotidectomy.

Finding and protecting the facial nerve are a challenge for the surgeon performing parotid surgery. The abnormal relationship between the retromandibular vein and facial nerve and its branches may increase the risk of facial nerve injury during surgery. In this clinical report, we have reported a 41-year-old female patient with pleomorphic adenoma undergoing superficial parotidectomy, and we have discussed a new variation of facial nerve-retromandibular vein relationship.

Low-temperature bipolar radiofrequency ablation (coblation) of the tongue base for supine-position-associated obstructive sleep apnea.

OBJECTIVE: To assess the effectiveness of low-temperature bipolar radiofrequency ablation for Coblation of the tongue base in the multilevel management of supine-position-associated obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND SETTING: A retrospective analysis of the data of 16 subjects undergoing uvulopalatopharyngoplasty and tongue base Coblation. The efficacy of the procedure was investigated on the basis of polysomnographic results. RESULTS: The success rate was 62.5% in 16 patients who underwent surgery for OSAS, with decreases in the mean Apnea Hypopnea Index of 20.1-8.9. The success rate was separately evaluated according to the subjects' posture. A rate of 87.5% was found for the supine position, while the rate was 56.6% in non-supine positions. The minimum postoperative O(2) saturation was significantly increased for REM and non-REM stage 3 sleep rates. CONCLUSION: It is important to evaluate the relation of the disease to the body position in sleep apnea subjects. Coblation of the tongue base is an applicable method of therapy for patients who have sleep apnea that is more marked in the supine position.

Otorhinolaryngologic examination in obstructive sleep apnea syndrome: the correlation between the severity of sleep disorder and physical examination.

OBJECTIVES: The aim of this study was to compare nasopharyngeal examination findings with those of polysomnography, which is considered to be the gold standard, in positional and nonpositional obstructive sleep apnea syndrome (OSAS) patients. PATIENTS AND METHODS: The study included 374 patients (215 males, 159 females; mean age 44.9 years; range 11 to 77 years) presenting with OSAS or simple snoring. Patients underwent polysomnography recordings and otorhinolaryngologic examination including fiberoptic nasopharyngoscopy with the Müller maneuver. The correlation of the data scoredwith the polysomnographic findings and body mass index (BMI) was investigated. The findings were assessed using the Mann Whitney U-test (anatomic findings) and Student t-test (Müller maneuver). RESULTS: Body mass index was correlated with apnea-hypopnea index (AHI), AHI-Lateral AHI-supine, the grade of the tongue base and neck circumference (p<0.05). In general, the dominant level of obstruction was at the soft palate level in patients with severe OSAS. There was a positive correlation between the grade of lateral obstruction at the soft palate level and AHI and AHI-lateral (p=0.01, p=0.02, respectively). The grade of anteroposterior obstruction at the tongue base level had a significant correlation with AHI- total and AHI-supine (p<0.05). The grade of the tonsillar hypertrophy revealed significant correlation with AHI-total and AHI-supine (p<0.05). There was no significant correlation between the degree of the nasal septal deviation and AHI (p>0.05). CONCLUSION: When upper airway obstruction is evaluated, AHI and positional AHI values should be used separately.