OBJECTIVE: To assess the clinical significance of vestibular aqueduct (VA) width measurement on high resolution CT images in pediatric patients with sensorineural hearing loss (SNHL).MATERIALS AND METHODS: 34 pediatric patients with sensorineural hearing loss (Group 1) and 42 controls without SNHL (Group 11) underwent otorhinolaryngological, otoneurological examinations, full audiological, sinusoidal harmonic acceleration evaluation and high resolution CT scan of temporal bone. VA width was measured at coronal and axial planes (at both midpoint and opercular levels).RESULTS: In control group, vestibular aqueduct mean width was [0.80 and 0.71] at right and left midpoint, [1.6 mm] at opercular level and (1.4 mm at right and 1.5 at left side) on coronal image. Enlarged vestibular aqueduct was in nineteen (55.9%) patients with SNHL. VA mean width was [2.62 and 2.35] at midpoint, [3.31 and 3.27 mm] at opercular level, and (2.8 mm and 3.24) on coronal images at right and left sides respectively. Sinusoidal Harmonic Acceleration (SHA) was abnormal in (47%) of children with SNHL; (68.8%) of them had enlarged VA.CONCLUSION: VA is enlarged; if it exceeded (1.2), (2.1) and (1.5) mm at midpoint, opercular level and on coronal images respectively. Incidence of enlarged vestibular aqueduct is higher with severe to profound hearing loss. Incidence of gain abnormality in rotational testing is common in patients with enlarged vestibular aqueduct. Most children with enlarged vestibular aqueduct have combined audio-vestibular dysfunction.
OBJECTIVE: To compare effectiveness of four different treatment protocols in idiopathic sudden hearing loss (ISHL). Patients and Methods: The patients with ISHL were divided into four groups according to the treatment protocols applied; Group 1 (n=67) was treated with rheomacrodex, pentoxyphiline, heparin, papaverine, famotidine, and methylprednisolone 1 mg/kg/day iv. Group 2 (n=39), group 3 (n=19) and group 4 (n=60) were treated with acyclovir, famotidine, and methylprednisolone (1 mg/kg/day, 2 mg/kg/day and 3 mg/kg/day, respectively). The symptoms and audiologic parameters were compared between the groups.RESULTS: The PTAs (pure tone averages), and HG (hearing gain), RHG (relative hearing gain) and RR (recovery rate) scores of the groups were not significantly different (p > 0.05). When the commencement of treatment was < 5 days; the HG in group 1 was better than group 3; the RHG in group 4 was better than group 3; and the RR in group 1 was better than group 3 (p < 0.05). When the commencement of treatment was between 5 and 10 days, there was no significant difference between the HG, RHG and RR scores of the groups (p > 0.05). When the commencement of treatment was > 10 days, the HG, RHG and RR scores in group 3 were better than in the other groups (p < 0.05), respectively.CONCLUSION: Overall comparison of the treatment protocols did not reveal significant difference between the outcomes.
OBJECTIVE: To evaluate involvement of ossicular chain with tympanosclerosis and their effects on hearing loss and to compare the results of mobilization or stapedectomy in stapes fixed tympanosclerosis.MATERIAL AND METHODS: Seventy three patients operated for tympanosclerosis were retrospectively analyzed. Sixty-four ears with tympanosclerosis were mobilized with Type I tympanomastoidectomy and 9 ears were applied total stapedectomy in a two-stage surgery. Pre-and postoperative air-bone gap pure tone average and the average hearing gain were analyzed using a four frequency (500,1000,2000,and 3000Hz). Six months to 3 years of follow-up are provided.RESULTS: Type III tympanosclerosis patients had the most severe hearing loss whereas type 11 tympanosclerosis patients had minimal hearing loss. With mobilization surgery preoperative air-bone gap of 23.5 dB in type II tympanosclerosis decreased to 12 dB postoperatively in 3 years whereas in type III and IV cases, preoperative air-bone gap of 34.5 and 28.2 dB decreased to 21.3 dB and 24 dB respectively. In 17 cases which their stapes were mobilized; preoperative air-bone gap of 29.7 decreased to 23.9 dB postoperatively in 2 years. In 9 cases which the stapedectomy was performed the air bone gap was decreased from 35.3 dB to 7.4 dB. Hearing gains among the cases which mobilization and stapedectomy were performed was found to be 7.2 dB and 25.3 dB respectively in 2 years.CONCLUSION: Hearing results were negatively affected when stapes fixation in tympanosclerosis was treated by mobilization. The best hearing results in these cases were obtained in two conditions: (a) by applying total ossicular replacement prosthesis during stapedectomy in the second-stage surgery in case of attic fixation and incus-malleus could not be mobilized; and (b) by applying stapedectomy and inserting teflon piston in case of incus-malleus was managed to be mobilized.
OBJECTIVE: Controlled hypotension is used to improve surgical conditions during middle ear surgery. New short acting drugs allow control of intraoperative blood pressure and improve surgical field for the surgeon. Our purpose is to determine whether remifentanil or esmolol could induce controlled hypotension, provide a dry operative field.MATERIAL AND METHODS: Thirty six adult patients undergoing tympanoplasty had an induction with propofol 2 mg/kg, fentanyl 1 (g/kg and vecuronium 0.1 mg/kg were randomly assigned in two groups to receive either 1 (g/kg remifentanil iv in 30-60 seconds, followed by a continuous infusion of 0.25-0.50 (g/kg/min, or 500 (g/kg esmolol iv in 30 seconds, followed by a continuous infusion of 100-300 (g/kg/min.RESULTS: Controlled hypotension was achieved at the target systolic arterial blood pressure of 80 mmHg in the groups, within 222,00 79,65 sec in remifentanil group and 658,94 176,64 sec in Esmolol group. The duration of hypotension was 100,33 7,79 minutes in remifentanil group and 64 4,37 minutes in esmolol group. There were no difference in the mean arterial blood pressure (mmHg) values at sistolic arterial pressure of 80 mmHg between the groups. Heart rate was lower in Remifentanil group (Group R) than Esmolol group (p<0.05). Mean arterial blood pressure was lower in Remifentanil group than Esmolol group (p<0.05). There was significant decrease in Surgical Field Rating in Esmolol group for the first 20 minutes, but the maximum bleeding scores in Esmolol group was higher than Group R for the first 60 minutes.CONCLUSION: Our study showed that remifentanil was preferable in providing good, stable and reliable surgical conditions in terms of quality of operative field and provided convenient induced hypotension for tympanoplasty.
Giant dolichoectatic aneurysms in the vertebrobasilar system are rare. They usually manifest themselves when they compress the brainstem or cranial nerves, or when they are complicated by intraluminal thrombi or dissection. A 63-year-old man presented with a 6-month history of progressive left-sided hearing loss and tinnitus, in addition to having hearing loss in the right ear since childhood. In audiological assessment total hearing loss was present in the right ear, while a mild degree of sensorineural hearing loss was noted in the left ear, especially at high frequencies. Speech discrimination was lower than normal, which was inconsistent with the degree of measured hearing loss, suggesting retrocochlear pathology. The tone decay test was positive for the left ear. All these findings, including an auditory brainstem response test, suggested the existence of retrocochlear pathology on the left side. Temporal-cranial MRI and cerebral angiography revealed a dolichoectatic basillar artery aneurysm that was compressing brainstem and bilateral tortuous dolichoectatic vertebral arteries compressing the root entry zones of the 7-8(th) cranial nerves. No surgical or vascular interventional treatment was recommended because of the high risk of complication based on the location of the lesion. After 1 year of anti-aggregant and anti hypertensive treatment, audiological tests revealed total hearing loss in the left ear. Anti-aggregant and antihypertensive treatment was continued.
Despite the availability of new antibiotics, chronic otitis media can still lead to major complications in developing countries. Except for mastoiditis, it is rare to see more than one complication in one patient simultaneously. We present the case of a 21 year old female who presented with facial nerve paralysis, labyrinthine fistula and brain abscess due to chronic otitis media. It is emphasized that preoperative findings such as facial nerve canal defect and labyrinthine fistula should raise the suspicion of the possibility of development of further and more serious complications such as abscess of the brain.
OBJECTIVE: To determine the efficacy of the xylitol in chewing gums in combination with the antibiotics for treatment of the chronic otitis media with effusion.STUDY DESIGN: Prospective, randomized, single blinded.METHODS: 29 patients with chronic otitis media with effusion were given xylitol or sorbitol containing chewing gums in a constant dosage with antibiotics. They were followed up monthly and at the end of 3 months, tympanometry was performed to all children whose ear condition were recorded according to otoscopic examinations and tympanograms.RESULTS: In the xylitol group, the,middle ear pressure for the right ear before the treatment was -347,71 +/- 60,04 daPa, whereas it was decreased to -230.00 +/- 123.88 daPa (p <.01) after the treatment. In the sorbitol group the middle ear pressure for the right ear before the treatment was 351.57 +/- 80.29 daPa, and it was decreased to -321.36 +/- 62.90 daPa (p <.05) after the treatment. In the xylitol group, the middle ear pressure for the left ear before the treatment was -312.14 +/- 87.38 daPa, whereas it was decreased to -154.4 +/- 185.27 daPa (p <.05) after the treatment. In the sorbitol group the middle ear pressure decrease for the left ear after the treatment was not found statistically significant (p >.05). The patients who received xylitol containing chewing gums had more improvement in the pressure levels for the right and the left ears than those in the sorbitol group.CONCLUSION: In the treatment of chronic otitis media with effusion, the chewing gums containing xylitol have been more effective than sorbitol containing gums.
BACKGROUND: The histopathological characteristics of cholesteatoma are hyperproliferation and differentiation of the epithelium. The proliferative capacity of cholesteatoma was studied through the kinetics of the epithelium of cholesteatoma. The present study was undertaken to compare the rate of proliferation and apoptosis using immunohistochemistry with PCNA antigen and p53 protein in cholesteatoma and skin of external auditory canal.MATERIAL AND METHODS: The expression and location of tissue PCNA and p53 were investigated in 29 samples of cholesteatoma and 8 skin specimens obtained during ear surgery. The tissues was fixed in formalin and embedded in paraffin for immunohistochemistry carried out using antibodies to PCNA and p53.RESULTS: Strong expression of PCNA was observed in spinous and granular layer of the epithelium in 41.4% cases of the cholesteatomas (mean positive rate 7.6 +/- 3.4). In the skin, PCNA was present only in single cells of the epidermis. Protein p53 was present in 14.7% of investigated samples of cholesteatoma (mean positive rate 13.8 +/- 2.2). The strongest expression of p53 was observed in the nucleus of the keratinocytes in granular layer of cholesteatoma epithelium. Presence of p53 in the skin was shown only in single cells of the epidermis.CONCLUSIONS: Cholesteatoma epithelium is characterized by increased expression of p53 and PCNA. Proliferative activity is mainly observed in the granular layer of the epithelium of cholesteatoma. We observed an increase in the rate of proliferation and disregulation in the cholesteatoma epithelium when compared with normal skin of auditory canal.
OBJECTIVE: To establish the presence of biofilms in surgical tissue specimens from patients with chronic otitis media.MATERIAL AND METHODS: 22 patients with chronic otitis media scheduled for tympanomastoid surgery were enrolled in this study between September 2007 and January 2008. Biopsies of the middle ear mucosa and cultures were taken at the time of surgery. Tissues were cultured using conventional methods for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae and Staphylococcus aureus. Bacteria identification was performed using the Becton Dickinson automatic identification system. Slime forming ability was tested on congo red agar for culture positive bacteria. The presence of icaA and icaD DNA were detected by polymerase chain reaction using forward and reverse primers for icaA and icaD for staphylococcus aureus.RESULTS: 6 of 22 patients' tissue specimens were culture-positive (72.7%). 5 Staphylococcus aureus and 11 Pseudomonas aeruginosa were identified on 16 specimens. Bacterial biofilms were present on 9 of 16(56.2%) culture-positive specimens. 2 of 5(40%) Staphylococcus aureus and 7 of 11 (63.6%) Pseudomonas aeruginosa produced bacterial biofilms.CONCLUSION: Pseudomonas aeruginosa was the most commonly bacteria in chronic otitis media. Biofilm forming ability was higher in Pseudomonas aeruginosa compared with other bacteries. The presence of biofilms on the mucosa of patients with chronic otitis media offers a possible cause of antimicrobial therapy failure.
INTRODUCTION: In our study, relationship between hearing loss due to acoustic trauma and serum levels of vitamin B12, tolic acid, zinc, magnesium and malondialdehyde were investigated.MATERIAL AND METHODS: The study was carried out on 135 healthy male individuals who were subjected to 138 dB sound intensity level. The mean age was 22 years. Pure-tone audiometry tests including high frequencies were performed to all individuals at one day before, same day and one month later with reference to the time of acoustic trauma. One day and four days after acoustic trauma, serum levels of vitamin B12, folic acid, zinc, magnesium and malondialdehyde were measured.RESULTS: After acoustic trauma, notch type hearing loss at 4000 Hz frequency was observed in 83 of the participants. However there was no significant difference among high frequency audiometry thresholds (p > 0.05). There was a statistically significant difference between serum levels of malondialdehyde before and after acoustic trauma in all subjects (p < 0.05). There was no significant relationship between hearing loss due to acoustic trauma and serum levels of vitamin B12, folic acid, zinc and magnesium (p > 0.05).CONCLUSION: These results indicate that free oxygen radicals play a role in the pathophysiology of acoustic trauma even though it is not directly related to the serum levels of vitamin B12, folic acid, zinc and magnesium.
Selection criteria for cochlear implantation have been broadened in recent years. However, selection of patients who are using immunosuppresive drugs because of organ transplantation is not very clear. We intended to share one of our patients who was on chronic immunosuppression due to kidney transplantation. We didn’t experience wound infection, delay in wound healing or any complication in our patient. We concluded that cochlear implantation of carefully selected patients receiving chronic immunotherapy after organ transplantation may be safe and effective, but report of large series of cochlear implantation performed on organ transplant patients is needed for a definitive conclusion. Department of Otorhinolaryngology Head and Neck Surgery (M. Sar›, Z.M. Yaz›c›, A.C. Yumuflakhuylu, C. Batman), Department of Audiology (U. Derinsu) Marmara University School of Medicine ‹stanbul, Turkey
OBJECTIVE: To investigate histopathologic differences between chronic otitis media (COM) with cholesteatoma and COM without cholesteatoma.MATERIALS AND METHODS: This retrospective study is an analysis of 74 middle ear biopsies from the promontory near the round window taken at first operation for COM performed. Thirty ears had COM with cholesteatoma. The other 44 ears had COM without cholesteatoma. Materials were stained by Hematoxylin-eosin and Toluidine blue. Density of gland and secretory cell, epithelial thickness, number of ciliated cell, infiltration and migration of chronic inflammatory cells (lymphocyte and plasma cell) and grade of vascular dilatation and proliferation between the patients with or without cholesteatoma were compared. The analysis of quantitative parameters was performed using Pearson chi(2) test.RESULTS: Infiltration and migration of lymphocyte and plasma cells, and grade of vascular dilatation and proliferation were significantly greater in ears without cholesteatoma than those with cholesteatoma.CONCLUSIONS: These findings indicate that distinct physiopathologic mechanisms may play role in development of COM in terms of presence of cholesteatoma. Cholesteatoma may lead to destruction of vascular structures and chronic inflammatory cells by means of its pressure effect, numerous enzyme and cytokines.
Bilateral facial paralysis is an unusual clinical entity that occurs in less than 1% of patients with facial paralysis. In children, bilateral facial paralysis is even rarer. The etiological assessment can be difficult. Herpes Zoster can cause serious infections, bilateral facial paralysis and Ramsay Hunt syndrome in pediatric patients. In this paper we report the first case in the literature according to our knowledge, with bilateral facial paralysis due to Ramsay Hunt syndrome in a pediatric patient.
OBJECTIVE: This study was conducted to determine the clinical value of diffusion-weighted magnetic resonance imaging (MRI) (DWI) in detecting the presence of cholesteatoma.MATERIALS AND METHODS: Fifty-six patients (21 female and 35 male; mean age, 43 years old) who underwent middle ear surgery were referred to the Radiology Department for preoperative DWI study. MRI (1.5-T) was performed using fast advanced spin echo (FASE) DWI, T2-weighted spin echo imaging (T2WI), and T1-weighted spin echo imaging (T1WI).RESULTS: DWI identified 41 of 48 cholesteatomas involving the middle ear cavity (sensitivity, 85.4%). Seven patients with middle ear cholesteatoma who showed negative DWI findings (false-negative cases) had limited keratin accumulation due to simple atelectasis or meticulous evacuation of keratin debris before the MRI study. No false-positive cases were found in this study (specificity, 100%). The positive and negative predictive values were 100% and 53.3%, respectively. The minimum size of middle ear cholesteatoma detected by the current MRI system was 5mm.CONCLUSION: DWI was useful for the detection of middle ear cholesteatoma.
Bell’s palsy (spontaneous idiopathic facial paralysis), which is the most common facial nerve disease, has a sudden onset. Although it is common in adults, Bell’s palsy is rare in children. And its recurrence is uncommon in adults and children. Bilateral simultaneous Bell’s palsy in children is rarely reported. We describe the diagnosis and treatment of a 4-year-old boy with left-sided Bell’s palsy that recurred in the right facial nerve 3 weeks after the conclusion of corticosteroid therapy for the first episode of paralysis. Departments of OtolaryngologyHead and Neck Surgery (Leyla Kansu) Department of Pediatrics (Nalan Yaz›c›), and Radiology (Tarkan Ergun), Baskent University, Ankara, Turkey
OBJECTIVES: The aim of this study was to increase the experience with N-butyl-2-cyanoacrylate in peripheral nerve anastomosis, to compare this group with primary suture, cyanoacrylate and control groups and to present our results and experience.MATERIALS AND METHODS: In the study, 49 adult male Sprague Dawley species rats were used, in the years 2004 and 2005. The study was planned as 4 groups; control group (n=10), suture group (n=12), cyanoacrylate group (n=14) and N-butyl 2-cyanoacrylate group (n=13). The right sciatic nerves of the rats were operated under general anesthesia in all groups. To measure the nerve conduction velocity (NCV), electrical stimulations were given by a stimulator using electrodes which were placed to the proximal end of the sciatic nerves and then the nerve conduction speeds were calculated by using a computer program.RESULTS: In the control group NCV was 58.6 +/- 0.7 m/s at the beginning and 55 +/- 1.3 m/s three months after the procedure and there was no statistically significant difference between them (p > 0.05). In the suture group, NCV at the beginning of the experiments was 57.1 +/- 0 6 m/s and., after three months, it was found to be 36.2 +/- 0.6 m/s (p < 0.01). In the cyanoacrylate group, the NCV before and three months after the experiments were 58.4 +/- 0.4 m/s and 44.7 +/- 1.1 m/s, respectively (p < 0.01). The NCV in the N-butyl 2-cyanoacrylate group was 58.5 +/- 0.4 m/s at the beginning and, after three months, it was found 47.4 +/- 1.2 m/s (p < 0.01).CONCLUSIONS: Our results support that, in the peripheral nerve repair, it is possible to get better electrophysiologic results by using N-butyl 2-cyanoacrylate and cyanoacrylate compared to the traditional microsuture technique.
OBJECTIVES: Describe the incidence of risk factors for hearing loss among NICU babies who failed at hearing screening.DESIGN: A total of 966 babies born at either university hospital or referred by the state maternity hospitals within near vicinity were screened during one year period. Madsen Accuscreen Pro Transient Evoked Otoacoustic Emission Measurement (TE-OAE) system was used for initial hearing screening. Year 2000 Position Statement: Principles and guidelines for early hearing detection and intervention programs prepared by Joint Committee on Infant Hearing were used for risk factors and to prepare hearing screening protocol. A total of 275 NICU babies were screened just before the baby discharge from the hospital and if the baby fails at first screen then follow up tests were done when the baby reach full term. Of 275 babies 151 (55%) were males and 124 (45%) were females.RESULTS: Descriptive analyses were used to describe characteristics of this sample. A total of 227 (83%) out of 275 NICU babies passed and 48 (17%) failed initial hearing screening and among them, 5 babies (1.8%) were diagnosed as hearing impaired at various degrees and they all were aided by the end of the first year.CONCLUSION: Bacterial meningitis, consanguinity and prolonged mechanical ventilation as well as prematurity and low birth weight are high risk factors of congenital hearing loss for babes in NICU.
INTRODUCTION: Electromagnetic middle ear implants which had been originally used in patients with high frequency hearing losses with normal middle ear conductive mechanism, recently were begun to be used on patients with defective or absent ossicles. Round window application of transducer of electromagnetic implant, first used by Colletti seems to be promising in such patients.OBJECTIVES: In this study indications and a modified technique of round window attachment of an electromagnetic implant (Vibrant Sound Bridge) are presented, and results obtained on 5 patients are discussed.MATERIALS AND METHODS: All patients had been implanted at Izmir Teaching and Research Hospital on 2007 - 2008. All cases were formerly operated in various centers because of cholesteatoma and all but one found to be free of residual or recurrent cholesteatoma during surgery. In all cases floating mass transducer has been applied onto the round window membrane in a perichondrial envelope. Patients were switched on 4-6 weeks after surgery.RESULTS: Pre-op AC levels were between 65-85 db (median 69.3) and BC levels were between 10. 1-60db (median 33.7). SDS scores were between 46-95 % (median 77.3) In all patients we have not seen any detoriation in these values after surgery. After switch on hearing thresholds with implant were elevated near to BC levels. SDS scores were considerably better in all patients (median 83) after surgery.
OBJECTIVE: This study aims to evaluate the variations of important structures by objective means for a safe otologic-neurotologic surgery.MATERIAL AND METHODS: Twelve temporal bones of six cadavers were dissected under surgical microscope with micro drill using jugular foramen approach. The distance between the second genu of facial nerve to the joint point of the chorda tympani (A); the distance between the nearest points of the sigmoid sinus and the facial nerve (B); the distance between the dome of the jugular bulb and the superior part of the round window niche (C) were measured.RESULTS: The mean and the standard deviation of the measured distances of A for right and left temporal bones were 10.75 +/- 2.17 mm (min = 9.30 max = 13.70) and 10.88 +/- 3.04 mm (min 7.80 max = 14-60 respectively. The mean values of B for right and left temporal bones were 5.71 +/- 2.08 mm min = 3.20 max = 7.65) and 6.03 +/- 1.74 mm (min = 4.00 max = 8.20 respectively. Right and left mean values and standard deviations for C were found as 6.67 +/- 2.85 mm (min = 3.40 max = 11.40) and 8.10 +/- 2.17 mm (min = 4.80 max = 11.90), respectively. Significant statistical correlation was found between right and left values regarding both A and B.CONCLUSION: The joint point of chorda tympani to the facial nerve and the nearest distance between the facial nerve and the sigmoid sinus may be useful to make a prediction of the other side of the temporal bone. The variation among the values of each parameter consisting of the minimum and the maximum measurements might be considered as a useful tool for choosing the best surgical approach for lesions of the temporal bone, jugular foramen and the posterior fossa. The surgeon may recognize serious limitations for a specific approach and may choose another access with the diagnosis of anatomic variations, such as anteriorly located sigmoid sinus and high jugular bulb, by preoperative radiological evaluation.
OBJECTIVES: To prevent lateralization of the graft, one of the most serious complications of myringoplasty or tympanoplasty, it is very important to place a graft medial to the malleal handle or to exteriorize a part or total handle of the malleus. In the grafting technique for which a part of the malleal handle is exteriorized by making it pass through a hole created in the fascia graft, it is the key point to clearly identify the hole made on the temporalis fascia and to quickly pass the malleal handle through a hole. Now we present here a simple surgical tip to identify the hole easily and facilitate passing the malleal handle through it.SETTING: Retrospective review; university-based hospital.SUBJECTS: Sixty-seven cases of overlay myringoplasty or tympanoplasty.RESULTS: Because our technique can allow the surgeon to better see the hole and to better handle the graft, it is useful regardless of the experience of the surgeon. In addition, any adverse effect of gentian violet has not reported in our cases.CONCLUSION: Our technique allows the clear identification of a hole on the temporalis fascia and helps the malleal handle pass much easier through a hole. Such improved identification of a hole can be very helpful for trainee residents or less-experienced surgeons.
