Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Comparison of 3-months treatment adherence and estimating residual apnea hypopnea index between home versus in-laboratory auto-titrating positive airway pressure titration.

PURPOSE: We aimed to assess the accuracy of home titration in estimating apnea hypopnea index (AHI) and optimal pressure values and to compare improvements in subjective daytime sleepiness, sleep quality and quality of life, along with 3-months treatment adherence of patients that received at-home versus in-laboratory auto-titrating positive airway pressure (APAP) titration. MATERIALS AND METHODS: In patients with a diagnosis of obstructive sleep apnea syndrome (OSAS), a study arm of laboratory attended APAP titration was compared with a study arm of home titration using an APAP device for three days. Subjective questionnaires were evaluated before and after 3 months of treatment. RESULTS: Fifty-three patients with newly diagnosed OSAS were enrolled. There was a significant positive correlation between PSG AHI and APAP AHI (rs  = 0.43, P = 0.003) and the fixed pressure for the APAP arm was positively correlated with the APAP PSG arm of the study (rs  = 0.71, P < 0.001). When the Bland-Altman graphs were compared, it was seen that the measurements obtained by the APAP AHI method were 0.3 units higher than the PSG AHI measurements, and that the mean of the measurement differences between the two methods was not different than 0 (P [H0 : Mean = 0] = 0.551). After 3 months of treatment, average nightly use was slightly higher in the APAP arm (P = 0.387). CONCLUSIONS: The results indicate that both titration methods were not clinically inferior in terms of a fixed optimal pressure, residual events, 3-months treatment adherence and change in subjective sleepiness, sleep quality and quality of life after treatment.

Does antenatal magnesium sulphate improve hearing function in premature newborns?

Objective: To evaluate whether antenatal magnesium sulphate (MgSO4) exposure has a neuroprotective effect against hearing impairment in premature newborns. Material and Methods: Retrospective cohort study was performed with prematurely (<37 weeks) delivered newborns at a tertiary university hospital. Newborns of 92 women who received MgSO4 infusions (study group) for various indications were compared to newborns of 147 women who did not receive MgSO4 infusions (control group). All eligible premature newborn underwent hearing screening by auditory brainstem response (ABR) testing before being discharged from the hospital. Results: The fail rate for ABR hearing screening was 3.3% (n=3) in the study group and 10.9% (n=16) in the control group (p=0.034). The rate of concurrent use of betamethasone was higher in the study group (72.8%; n=67) compared to control group (29.2%; n=43) (p<0.001). Other neonatal parameters, such as the number of neonates who were small for gestational age and the rate of microcephaly were similar between the groups (p=0.54, p=0.48, respectively). After adjusting for co-variates including the use of betamethasone and gestational age at delivery, no statistically significant association between antenatal administration of MgSO4 and ABR fail rates were found (p=0.07). Conclusion: These results do not suggest a significant benefit in terms of hearing impairment in premature newborns when antenatal MgSO4 infusion was given.

Prognostic significance of soft tissue deposits in laryngeal carcinoma / Importância prognóstica de depósitos de tecido mole no carcinoma laríngeo

Abstract Introduction: Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. Objective: To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. Methods: Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. Results: The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. Conclusion: In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Resumo Introdução: Depósitos de tecido mole são ilhas tumorais diferente dos linfonodos e ocasionalmente diagnosticados em amostras de esvaziamento cervical. Sua importância começou a ser reconhecida, mas seu valor não foi investigado no câncer de laringe como um único local de tumor. Objetivo: Investigar o valor prognóstico do depósito de tecido mole em pacientes com carcinoma laríngeo. Método: Os prontuários de 194 pacientes com carcinoma laríngeo tratados principalmente por cirurgia e esvaziamento cervical foram analisados. O significado prognóstico dos depósitos de tecido mole foi avaliado juntamente com outros achados clínicos e histopatológicos. As taxas de recidiva, as taxas de sobrevida geral e específicas da doença foram avaliadas. Resultados: Observou-se uma incidência de depósitos de tecido mole de 7,2% no carcinoma laríngeo. O estágio N foi mais avançado em pacientes com depósitos de tecido mole. A taxa de recorrência regional foi maior e as taxas de sobrevida geral e específica da doença foram significativamente menores nesses pacientes na análise univariada. No entanto, na análise multivariada, o depósito de tecido mole não foi observado como um fator de risco independente. Conclusão: No carcinoma laríngeo, o depósito de tecido mole foi diagnosticado em pacientes com doença cervical mais avançada, mas sua significância foi menor do que outros fatores, inclusive a extensão extranodal.

Is There a Change in the Treatment of T1 Glottic Cancer After CO2 Laser? A Comparative Study with Cold Steel.

OBJECTIVE: Carbon dioxide (CO2) laser provides high local control and disease-specific survival rates with minor morbidity and good quality of life in transoral cordectomy. We aimed to compare the oncological outcome and survival between cold steel and CO2 laser in the treatment of early glottic cancer. METHODS: In this retrospective study, the participants were divided into two groups. The first group comprised patients who were operated upon between 2001 and 2007 using cold steel (group 1, n=38), and the second group comprised patients who were operated upon between 2008 and 2016 using CO2 laser (group 2, n=88). Both groups were compared regarding age, gender, pathological grade, T stage, type of cordectomy, margin status, anterior commissure involvement, follow-up, locoregional recurrence, and disease-free survival (DFS). RESULTS: The overall survival rate and DFS were similar between the two groups (94.7% vs. 98.9% and 100% vs. 98.9%, respectively), and no association was found between surgical margin positivity and local recurrence. However, a significant association between the presence of anterior commissure involvement and recurrence was found in all 126 patients (p=0.016). Local recurrence was significantly higher in the group 2 (p=0.024), but it did not affect overall survival and DFS in these patients (100% vs. 94.1%). CONCLUSION: Although CO2 laser excision is considered to be superior to cold steel regarding surgical time and bleeding control, the local recurrence rates were found to be higher with the laser than the cold steel. Thus, we argue that cases should be selected more carefully concerning the anterior commissure, depth of tumor invasion lateral to vocal muscle, difficulty at endoscopic exposure for lesions with anterior commissure involvement, and reliability of surgical margins at frozen sections.

Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid change in head position, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study was to investigate and compare the effectiveness of Epley maneuver and Brand-Daroff home exercises for the treatment of posterior canal BPPV. METHODS: A total of 50 patients between 27 and 76 years of age who were diagnosed with unilateral posterior canal into BPPV were randomized prospectively into two groups. In Group-1, modified particle repositioning maneuver and in Group-2 Brandt-Daroff exercises were utilized as treatment. Patients were followed weekly. Cure weeks were recorded. The patients were followed for 12 to 24 months for recurrence. RESULTS: The recovery rates at the first, second and third week controls were 76%, 96% and 100% for Group-1 (modified Epley maneuver) and 64%, 88% and 100% for Group-2 (Brandt-Daroff exercises) respectively. The recovery rates were similar for both groups. The average follow-up duration was 18 months. In Group 1, 7 patients (28%) and in Group 2, 5 patients (20%) had recurrence, which was also similar with no statistical difference. CONCLUSION: It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers were almost equally effective in the treatment of BPPV.

Prognostic significance of soft tissue deposits in laryngeal carcinoma.

INTRODUCTION: Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. OBJECTIVE: To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. METHODS: Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. RESULTS: The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. CONCLUSION: In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Should Nasal Function be Considered Prior to Tympanoplasty?

OBJECTIVE: To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM). MATERIALS AND METHODS: The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month. RESULTS: Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%. CONCLUSION: Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.

Impact of Septoplasty on Eustachian Tube Functions.

OBJECTIVE: To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions. MATERIAL AND METHODS: The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months. RESULTS: Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group. CONCLUSIONS: Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.

The importance of the first three days and other diagnostic indicators in sudden hearing loss.

OBJECTIVES: This study aims to compare different therapy methods used for sudden sensorineural hearing losses, to determine the prognostic factors and particularly to investigate the importance of starting the therapy within the first three days of the prognosis. PATIENTS AND METHODS: Between January 1995 and December 2008, the files of 213 patients who were treated in our clinic were reviewed. A total of 155 patients who met the inclusion criteria were included in the study. The study groups were classified according to the prognostic and audiometric factors. RESULTS: With regard to the effectiveness of treatment options, post-treatment audiometric improvement was significantly better in the patients treated with carbogen in addition to the medical therapy compared to the other groups (p=0.018). In terms of the patient characteristics at the time of admission, having vertigo, presence of a descending type audiogram curve and severe hearing loss affected the success of treatment negatively, while mild hearing loss and presence of an ascending type audiogram curve had a positive effect. The recovery rate was higher in patients who were admitted within the first three days (p=0.005). CONCLUSION: It was found that starting the therapy within the first three days and adding the carbogen to the conventional medical treatment may improve the outcome of the treatment.

Comparison of Videonystagmography and Audiological Findings after Stapedotomy; CO2 Laser vs Perforator.

OBJECTIVE: Various types of laser, microdrill, and perforator are effectively used in the surgical treatment of otosclerosis. However, they have certain disadvantages along with advantages. The aim of this study was to evaluate the effects of carbon dioxide (CO2) laser and perforator stapedotomy techniques on audiological outcomes and postoperative vestibular functions via videonystagmography (VNG). MATERIALS AND METHODS: This prospective and randomized clinical study was conducted in an academic tertiary medical center. Sixty-nine patients diagnosed with otosclerosis who underwent stapedotomy were enrolled in this study. Patients were divided into two groups based on the technique used in stapedotomy: CO2 laser and perforator. Postoperative hearing gain and VNG findings were the main outcome measures. Subsequently, the two study groups were compared for analysis. RESULTS: The preoperative air-bone gap was 32.7±8.9 decibel (dB) in the study population and it was improved to 12.9±8.4 dB after operation. There were no differences in VNG findings and vertigo symptoms between the laser and perforator groups at postoperative day 2. There was no significant gain difference regarding the air conduction, bone conduction, and air-bone gap between the two groups (p=0.294, p=0.57, and p=0.37, respectively). CONCLUSION: Both CO2 laser and perforator stapedotomy have successful audiological outcomes with no difference in postoperative vestibular disturbance.

Reconstruction of orbital exenteration defects with bilobed forehead flap.

To describe the use of bilobed forehead flap for reconstruction of orbital exenteration defect. The medical records of 2 patients in whom orbital exenteration defect repair was performed with bilobed forehead flap were reviewed. In both patients (male, ages 74 and 65 years), extended exenteration was performed because of basal cell carcinoma infiltrating the upper and lower eyelids and orbit. One patient had a history of multiple eyelid surgeries and periorbital radiotherapy. In the other, the tumor also involved the maxillary and ethmoid sinuses and nasal dorsum. The bilobed flap was combined with a cheek advancement flap in 1 patient. The excisional defect could be primarily covered in both patients. In 1 patient, a skin graft was needed to cover the forehead donor area defect. In both patients, transient, distal flap ischemia developed after surgery and, in 1 patient, eyebrow malposition required surgical correction at the late period. No other complication developed during follow-up (18 and 26 months). The bilobed forehead flap can be effectively used to reconstruct total or extended orbital exenteration defects.

Comparison of Clinical Results in Nasal Tip Augmentation Either Via Face to Face or Back to Back Technique With Autogenous Auricular Conchal Cartilage.

OBJECTIVE: To compare the objective and subjective findings between patients who underwent nasal tip augmentation surgery via two different methods using autogenous auricular conchal cartilage. MATERIALS AND METHODS: This study included the data of 21 patients who underwent nasal tip augmentation surgery. The patients were randomly divided in two groups according to the technique used to form a double layer columellar strut graft; either face to face (group 1) and back to back (group 2). All patients were assessed via nasal obstruction symptom evaluation scale (NOSE) and via acoustic rhinometry and rhinomanometry at preoperative and postoperative 1st and 6th months. RESULTS: There was statistically significant improvement in symptom score in both patient groups with no difference inbetween. Total nasal resistance decreased nonsignificantly at the end of 6th month in both groups; 13.1 Pa/cm3 to 8.6 Pa/cm3 and 10.3 Pa/cm3 to 9.5 Pa/cm3 respectively. There was no significant increment in MCA values for both groups except left MCA1. CONCLUSIONS: We achieved good results in tip augmentation via both techniques. An autogenous conchal cartilage is a good alternative to replace lacking caudal septal cartilage. It provides safe and stable support to the nasal tip. However, further comprehensive studies with larger sample size and long follow-up are required to elucidate any difference between these two techniques.

The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response.

The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis.

An evaluation of the results of chemoradiotherapy and surgical treatment for hypopharyngeal cancer.

OBJECTIVES: This study aims to evaluate the efficacy chemoradiotherapy and surgical treatment in patients with hypopharyngeal cancer. PATIENTS AND METHODS: Between January 2003 and July 2009, 48 patients (31 males, 17 females; mean age 55.5±13.4 years; range 29 to 84 years) who were diagnosed with hypopharyngeal cancer were retrospectively evaluated. The patients were assigned into surgery (n=17) and chemoradiotherapy (n=31) groups. RESULTS: The overall survival of the patients with advanced disease in the surgery group was statistically higher than those in the chemoradiotherapy group. The recurrence rate of the patients was 35.3% in the surgery group, whereas it was 41.4% in the chemoradiotherapy group. CONCLUSION: Our study results indicated that the survival rates were higher in the surgery group. On the other hand, chemoradiotherapy had the advantage of laryngeal preservation.

Laryngeal plexiform neurofibroma in a child.

Neurofibromatosis (NF) is a genetically inherited, autosomal dominant disease, characterized by multiple cafe au lait spots, cutaneous neurofibromas and "Lisch nodules." Neurofibromatosis can develop from a neural source at any age. However, neurofibroma of the larynx is extremely rare and is usually manifested by obstructive airway symptoms. We encountered a 5-year-old child presenting with stridor and dyspnea, who had a diagnosis of laryngeal plexiform neurofibroma. The purpose of our report is the consideration of laryngeal NF in the differential diagnosis of dyspnea in infants and children.

Association between skin flap thickness and Frey's syndrome in parotid surgery.

BACKGROUND: Frey's Syndrome is a frequent complication of parotid surgery. The aim of this study was to evaluate the association between skin flap thickness and Frey's Syndrome in patients who underwent superficial parotidectomy. METHODS: Thirty adult patients were randomized into 2 groups: subcutaneous and subsuperficial musculoaponeurotic (sub-SMAS) skin elevation. In both groups skin flap thickness was measured by a micrometer at defined points. The patients were queried for subjective Frey's Syndrome and Minor's test was performed for objective Frey's Syndrome. RESULTS: The thickness of skin flap in the subcutaneous group was significantly less than that in the sub-SMAS group. There was no statistical significance between skin flap thickness and objective Frey's Syndrome, although the dimension of the colored area in the subcutaneous group was larger compared with that of the sub-SMAS group: 7.5 cm(2) (0-48 cm(2) ) and 0.5 cm(2) (0-18 cm(2) ), respectively. CONCLUSIONS: In conclusion, sub-SMAS elevation of the skin flap in parotid surgery provides better results regarding Frey's Syndrome.

The effects of levobupivacaine infiltration on post-tonsillectomy pain relief in adults: a single-blinded, randomized, and controlled clinical study.

The aim of this prospective single-blinded and controlled study is to evaluate the efficacy of levobupivacaine infiltration on post-tonsillectomy pain relief in adults. The study was conducted with 40 adult patients who underwent tonsillectomy. These patients were randomized in either study group (SG) who received levobupivacaine infiltration to peritonsillary fossae prior to surgery or control group (CG) with no medication. After surgery, all the patients were queried for pain scores by visual analog scale. In addition, the volume of intraoperative bleeding, the duration of operation, the severity of postoperative complications, and the amount of analgesic requirement were the other outcome measures of this study. There were significant differences between groups regarding pain scores for the first 24 h in favor of SG. The analgesic requirement was also significantly lower in SG (p = 0.009). Although there was a sustained decrement at pain score during first 24 h for SG, however, the change from baseline score (immediate score) for each time interval revealed no significance compared to CG. In addition, the duration of operation and the volume of intraoperative bleeding were similar (p = 0.64 and p = 0.165). In conclusion, preincisional infiltration of levobupivacaine is a safe and reliable method for post-tonsillectomy pain reduction in adults. However, more in-depth, double-blinded and placebo controlled studies are required to elucidate its long term benefits.

[The role of sentinel lymph node biopsy in oral cavity cancer]. / Oral kavite kanserlerinde sentinel lenf nodu biyopsisinin rolü

OBJECTIVES: This study aims to evaluate the role of sentinel lymph node (SLN) biopsy in patients who had clinically N0 oral cavity cancer in the neck assessment. PATIENTS AND METHODS: Between May 2006 and May 2008, nine patients with clinically N0 oral cavity cancer (6 females, 3 males; mean age 57±24.7 years; range 31 to 71 years) who underwent surgical treatment were enrolled in this study. Eight of them had corpus linguae carcinoma, while one had lower lip carcinoma. Tumor stages were T1 in four, T2 in four patients, and T4a in one patient. The patients underwent surgery within 8 to 16 hours after lymphoscintigraphy was performed for detecting SLNs. Initially primary tumor was excised. Then, SLNs which were identified by a gamma probe, lifting skin flap of the neck were excised. Neck dissection was performed as scheduled. SLNs were examined in frozen sections. The results of frozen section and definitive histopathological diagnosis of SLNs were compared with each other, as well as the definitive histopathological diagnosis of the dissection materials. RESULTS: In all patients SLNs were completely identified and excised successfully, including one node in one patient, two nodes in six patients and three nodes in two patients. All nodes were localized ipsilaterally in the neck. In addition, the frozen section and definitive histopathological examination results of all nodes were consistent. Biopsy results indicated that eight patients were SLN-negative, while one was SLN-positive. Only one patient was SLN-negative, although the pathological diagnosis was found to be N1. CONCLUSION: Our study results suggests that SLN biopsy may be applicable for early stage oral cavity tumors.

Is it the middle ear disease or the reconstruction material that determines the functional outcome in ossicular chain reconstruction?

OBJECTIVES: To evaluate the effects and the predictive value of environmental risk factors on the success of different reconstruction materials used in ossiculoplasty. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral university hospital. PATIENTS: Between January 2007 and October 2010, 110 patients who underwent ossiculoplasty with or without mastoidectomy due to chronic otitis media were enrolled in the study. All patients were classified into 1 of the 3 risk groups (mild, moderate, and severe) according to their measured Middle Ear Risk Index score. INTERVENTIONS: The patients underwent exploratory tympanotomy, tympanoplasty, or tympanomastoidectomy (canal wall-up or wall-down), all with ossicular reconstruction. The ossicular reconstructions were performed using either bone cement, autologous bone interposition, or allograft material. MAIN OUTCOME MEASURES: For each patient, the air-conduction threshold and air-bone gap (ABG) were measured at the 12th month after ossiculoplasty. The ABG gain and air-conduction improvement were compared with preoperative values. The correlation of the success of ossiculoplasty with the middle ear risk group of patients was investigated. Moreover, the efficacy of different types of reconstruction material on the success of ossiculoplasty in the same risk group was evaluated. RESULTS: In the mild- and moderate-risk groups, the ABG gain (p = 0.001 and p = 0.014) and air-conduction improvement (p < 0.001 for both) were statistically significant, whereas those changes were found to be insignificant in the severe-risk group. Moreover, the ABG gain and air-conduction improvement in none of the risk groups revealed a significance in favor of any of the used reconstruction materials. CONCLUSION: The results of this study revealed that none of the reconstruction materials or specific techniques have a superiority in the functional outcomes in patients from the same middle ear risk group. We conclude that the success of ossiculoplasty is highly correlated with the pathophysiological status of the middle ear and is independent of the type of replacement material.