Audiological evaluation in patients with Behçet's disease.

OBJECTIVE: This study aimed to determine the characteristics of hearing loss in patients with Behçet's disease. METHODS: Twenty-six consecutive patients with Behçet's disease and a control group consisting of 25 age-matched healthy subjects were prospectively included in this study. Pure tone and speech audiometry, tympanometry, distortion product otoacoustic emission testing, and auditory brainstem-evoked response assessment were performed in the patients and controls. RESULTS: The pure tone audiograms and the results of distortion product otoacoustic emission testing showed statistically significant hearing loss in the Behçet's disease patients (p < 0.05). Auditory brainstem-evoked response results were not significantly different between the patients and controls (p > 0.05). CONCLUSION: The findings of the present study demonstrated that audiological involvement is more frequent in patients with Behçet's disease than in healthy controls. Therefore, all patients with Behçet's disease should be regularly monitored by an otolaryngologist and be given information about the possibility of inner-ear involvement.

Protective effects of vitamins E, B and C and L-carnitine in the prevention of cisplatin-induced ototoxicity in rats.

OBJECTIVE: This experimental study aimed to investigate the effects of vitamins E, B and C and L-carnitine in preventing cisplatin-induced ototoxicity. METHODS: Twenty-five adult, male, Wistar albino rats were randomly allocated to receive intraperitoneal cisplatin either alone or preceded by vitamins B, E or C or L-carnitine. Auditory brainstem response (i.e. hearing thresholds and wave I-IV intervals) and distortion product otoacoustic emissions (i.e. signal-to-noise ratios) were recorded before and 72 hours after cisplatin administration. RESULTS: The following statistically significant differences were seen: control group pre- vs post-treatment wave I-IV interval values (p < 0.05); control vs vitamin E and B groups' I-IV interval values (p < 0.05); control vs other groups' hearing thresholds; vitamin E vs vitamin B and C and L-carnitine groups' hearing thresholds (p < 0.05); and vitamin B vs vitamin C and L-carnitine groups' hearing thresholds (p < 0.05). Statistically significant decreases were seen when comparing the initial and final signal-to-noise ratios in the control, vitamin B and L-carnitine groups (2000 and 3000 Hz; p < 0.01), and the initial and final signal-to-noise ratios in the control group (at 4000 Hz; p < 0.01). CONCLUSION: Vitamins B, E and C and L-carnitine appear to reduce cisplatin-induced ototoxicity in rats. The use of such additional treatments to decrease cisplatin-induced ototoxicity in humans is still under discussion.

Effect of antioxidants on the clinical outcome of patients with nasal polyposis.

AIM: To investigate the therapeutic effects of antioxidants on the clinical and biochemical outcome of patients with nasal polyposis. METHODS: Thirty-four patients with nasal polyposis were divided into two groups receiving either intranasal steroid or intranasal steroid plus per-oral vitamins A, C and E and selenium. Paranasal sinus computed tomography, endoscopy, and polyp tissue and serum sampling were conducted pre- and post-therapy. Serum levels of malondialdehyde, superoxide dismutase, nitrite and myeloperoxidase and tissue levels of malondialdehyde and superoxide dismutase were measured. Group results were compared using the Mann-Whitney U test and Wilcoxon signed-rank test. RESULTS: Both groups had significantly lower tissue parameters, computed tomography scores and serum malondialdehyde levels, comparing pre- versus post-treatment results. Post-treatment, the steroid plus antioxidant group had significantly lower tissue malondialdehyde levels and a greater fall in tissue and serum malondialdehyde, compared with the steroid group. CONCLUSION: Serum and tissue levels of malondialdehyde (an oxidative marker) were significantly decreased by adding antioxidants to standard therapy. This is the first report of the positive effects of adding antioxidants to steroid therapy for nasal polyposis.

Prevalence of sphenoid sinus agenesis in adults: a CT scan study.

OBJECTIVE: Sphenoid sinus agenesis is a very rare entity. In this study, we evaluated the CT scans of 1193 patients and detected cases with sphenoid sinus agenesis despite the absence of craniofacial anomalies or syndromes. METHODS: The CT scans of 1193 patients who had undergone endoscopic sinus surgery in our clinic between 1999 and 2008 were retrospectively evaluated. Of the patients, 652 (54.6%) were female and 541 (45.3%) were male. The mean age of the patients was 32 years (range: 13-75 yrs.). RESULTS: In this study, we identified eight patients (0.67%) with sphenoid agenesis. Three patients (37.5%) had bilateral, 3 patients (37.5%) had left, and 2 patients (25%) had right sphenoid agenesis. None of the patients had craniofacial anomalies or syndromes. CONCLUSION: Sphenoid sinus agenesis is rarely seen in the absence of craniofacial anomalies or syndromes. In our study, its incidence was 0.67%. Awareness of sphenoid sinus agenesis and/or hypoplasia is very important, particularly when transphenoidal hypophysectomy is planned.

An unusual pneumatisation of turbinates.

OBJECTIVE: To report an extremely rare case of pneumatisation of all turbinates. CASE REPORT: A 17-year-old male patient presented with nasal obstruction. Anterior rhinoscopy and nasal endoscopic examination revealed left middle turbinate and bilateral inferior turbinate hypertrophy, septal deviation to the right. A coronal computed tomography (CT) scan of the paranasal sinuses showed pneumatisation of both superior and inferior turbinates and a left middle turbinate, and also showed pneumatisation of the right middle turbinate. The patient underwent endoscopic sinus surgery of the left side with lateral lamellar resection of the middle turbinate under local anaesthesia. CONCLUSION: We present the first case in the world literature of the pneumatisation of all six turbinates.

Nasopharyngeal tuberculosis: an unusual cause of nasal obstruction and snoring.

OBJECTIVE: To report an extremely rare case of nasopharyngeal tuberculosis. CASE REPORT: A 35-year-old male patient presented with nasal obstruction and snoring. Nasal endoscopic examination with a rigid endoscope revealed a large mass on the posterior wall and roof of the nasopharynx. A computed tomography scan of the nasopharynx revealed a polypoid mass in the posterior nasopharyngeal wall. Histopathological examination of a biopsy taken from the posterior nasopharyngeal wall revealed granulomatous lesions with caseation necrosis. Treatment was decided after histopathological examination and intradermal positive reaction to tuberculin test, and started a week later. The patient was treated with antituberculosis drugs including isoniazid, rifampicin, pyrazinamide, and ethambutol. After six months, the nasopharyngeal examination was absolutely normal, and the patient was also symptom free. CONCLUSION: This case highlights that nasopharyngeal tuberculosis should be considered in the differential diagnosis of a nasopharyngeal mass, especially in patients from regions of the world where tuberculosis is endemic.

Preliminary results on correlation between neural response imaging and 'most comfortable levels' in cochlear implantation.

During cochlear implantation, precise placement of the cochlear electrodes against the cochlear nerve is one of the most important steps, necessary to enable the patient to be aware of the stimulus from the implanted device. Neural response imaging (NRI) is a new tool which measures the evoked compound action potential generated as a result of electrical stimulation of the cochlea by properly placed electrodes during surgery. The aim of this study was to examine the correlation between intra-operative NRI recordings and 'most comfortable levels' (M levels) measured during standard fitting with the SoundWave fitting software, in cochlear implantation patients. Seven adult subjects were included in the study. The average duration of profound bilateral deafness was seven years (range = 19 years) and the mean age at implantation was 24 years (range = 17-34 years). All subjects underwent implantation and reached the one-month fitting session; one patient reached the two-month fitting session. The intra-operative NRI threshold (tNRI) was observed to be much higher than the first fitting M levels. The tNRI was 203 per cent of the sequential M value and 246 per cent of the paired M value. All but one intra-operative tNRI values were greater than 150 clinical units (CU), and all first fitting M levels were on average below 100 CU. No obvious correlation was found between individual intra-operative tNRI and first fitting M levels. The M levels at one month were much higher than the first fitting M levels, with much more dispersion.