Objectives/HypothesisTo investigate the effect of continuous positive airway pressure (CPAP) on middle ear pressure in patients with obstructive sleep apnea syndrome (OSAS).Study DesignProspective clinical case‐control study.MethodsSeventy‐eight patients with moderate and severe OSAS (the mean apnea‐hypopnea indexes were 22.70 ± 3.59 and 48.59 ± 12.50, respectively) using CPAP (study group) and 60 patients with no sleep apnea syndrome (control group) were included in the study. Forty‐two of the patients were female and 96 were male. The mean age in the study group was 47.38 ± 6.23, whereas it was 46.10 ± 11.96 in the control group (P > .05). The middle ear pressure of all study subjects was evaluated with tympanometry at the beginning of the study and 6 months later. Tympanometric measurements of both groups were compared. Furthermore, the same data for the study group were also evaluated according to CPAP pressure levels.ResultsThe middle ear peak pressure values of the patients in the study group were significantly increased from −63.04 ± 55.82 daPa to −39.6 ± 27.72 daPa after 6 months (P < .01). The middle ear pressure in the control group was found to be −13.26 ± 22.60 daPa at the beginning of the study and −13.60 ± 38.82 daPa after 6 months (P > .05). The mean middle ear pressure level was significantly higher in patients using CPAP at 12 to 14 cm H2O pressure than in those using CPAP at 8 to 10 cm H2O pressure (P < .05).ConclusionsThere was a significant increase in the middle ear pressure of patients using CPAP regularly for 6 months. This increase was proportional to the pressure level of the CPAP device.Level of Evidence3b.

Objective: To examine the middle ear pressure changes after the uvulopalatal flap surgery.Materials and Methods: Fifty-three patients were scheduled to undergo uvulopalatal flap surgery with or without tonsillectomy; and 25 patients were admitted to clinic acted as the control group. The middle ear pressure was measured using tympanogram at the beginning of the study, and postoperatively at the 1st. month and the 6th. month for the study group, and at the 6th. month for the control group. The results were compared with respect to the type of surgery. In the groups that underwent surgery, both those with and without ear pain had middle ear pressure comparisons done.Results: Both groups showed a statistically significant negative change in the tympanogram value. While the negative change continued throughout the 6 months period, a slight improvement was seen when comparing the first and sixth postoperative month. The normalization of the middle ear pressures, at the first to the sixth postoperative month, was statistically significant. The negative change was significantly higher in the group that had postoperative ear pain complaints.Conclusion: Uvulopalatal flap surgery, or uvulopalatal flap surgery with tonsillectomy, cause negative pressure changes in the middle ear and by the time, this pressure changes return to normal. Patients who are going to undergo these procedures should be informed that they might experience some ear discomfort after the surgery.

Objectives: To investigate the radiologic and polysomnographic success in opening the airway using a tongue base suspension procedure alone or in combination with uvulopalatal flap in obstructive sleep apnea syndrome (OSAS) patients.Methods: This study was conducted in 20 patients with moderate or severe OSAS in a prospective manner. The tongue base suspension technique alone or with a uvulopalatal flap (UPF) technique was applied. Magnetic resonance imaging (MRI) scans of patients obtained during the preoperative period and at the 5th week of the postoperative period were compared. Changes in pain and swallowing difficulties were assessed. Polysomnography (PSG) was applied at the 12th postoperative month, and body mass index (BMI) and Epworth sleepiness scale (ESS) values were determined. The degree of satisfaction relative to the surgery was assessed with 4 questions.Results: Preoperative apnea-hypopnea index (AHI) level was found to be 24.55 +/- 9.87, whereas postoperative AHI level was 12.40 +/- 9.87 (P < 0.01). The success rate was determined to be 60%. Preoperative ESS values were 13.90 +/- 2.67 and were reduced to 6.55 +/- 3.13 postoperatively (P < 0.01), and the preoperative posterior airway space (PAS) level was 10.08 +/- 1.23, which was increased to 11.64 +/- 1.46 postoperatively (P < 0.01). Visual analog scale (VAS) values for swallowing difficulty were 8.62 at day 1 and decreased to 3.98 at Clay 7. The VAS values for pain were 9.14 at day 1, but were reduced to 4.18 at day 7.Conclusions: Patients with OSAS who have hypertrophy of the tongue base may safely receive a tongue base suspension procedure, which is a minimally invasive method. The postoperative hospital stay is short and the success rate is high, as shown with both PSG and MRI. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

OBJECTIVES:In this study the efficacy of palatal implants for treatment of snoring was evaluated.PATIENTS AND METHODS:Seventeen patients (10 males, 7 females; mean age 49.2+/-7.8 years; range 31 to 66 years) with primary snoring and an apnea-hypopnea index of less than 15 were treated with palatal implants after clinical and endoscopic examination. Snoring-related symptoms were evaluated at baseline and 90 days after surgery and polysomnography was performed. Patients and their spouses completed questionnaires and visual analog scales (VAS) evaluating snoring, apneas, and the intensity, duration, and social effects of daytime sleepiness at baseline and 90 days after surgery. Pre- and postoperative assessment results were compared.RESULTS:Epworth sleepiness scale score was significantly decreased in the postoperative period (p<0.05). Postoperative mean VAS snoring, apnea, and daytime sleepiness scores were also significantly improved (p<0.01). No patients reported worsening of apnea, 5.9% of patients reported no change in apnea, and 94.1% of patients reported a marked decrease in apneas. In the postoperative period, 76.4% of patients reported reduced snoring, and 88.3% of patients reported reduced daytime sleepiness.CONCLUSION:Palatal implants have been demonstrated to be a safe and effective treatment for snoring with minimal patient discomfort. Establishing realistic pretreatment expectations can maximize patient satisfaction.

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 aim of this study was the evaluation of length of the procedure, anaesthesia, the amount of the intraoperative fluid required, total blood loss and postoperative pain of the 'thermal welding system tonsillectomy (TWS)' compared with the conventional 'cold dissection tonsillectomy'. METHODS:Fifty patients aged between 3 and 28 years were included in this prospective controlled study. Extracapsular tonsillectomy with TWS was carried out on 25 patients and conventional 'cold' extracapsular dissection complete tonsillectomy was carried out on the other 25 patients. Haemostasis was achieved with packing and 3/0 chromic catgut suture is used to treat the persistently bleeding sites in the 'cold' tonsillectomy group. Intraoperatively, the duration of the procedure, anaesthesia, the amount of the required intraoperative fluid, the total blood loss and the number of sutures were documented for each patient. In the hospital, the postoperative amount of intravenous fluids, oral intake (timing of onset and amount), the duration and the total dose of analgesics were recorded. Daily assessment included the type of diet, the level of appetite, the total number of analgesics, the presence of fever, the time required to return to normal activity and the pain score (twice daily). Pain was measured by means of Faces Pain Scale and Visual Analogue Scale. RESULTS:There was a statistically and clinically significant difference in the operating time in the intraoperative blood loss in favour of the conventional tonsillectomy group (P > 0.05). Although there was no statistically significant difference between the two groups for the postoperative evening pain scores (P > 0.05), there was a statistically significant difference for the morning pain scores (P < 0.05) in the first 2 days postoperatively (P > 0.05) and in the level of appetite in the first postoperative day (P > 0.05). The other outcome measures did not show any statistically significant difference. CONCLUSION:When we compared TWS with the conventional 'cold' dissection tonsillectomy, we found that TWS tonsillectomy offered an innovative new tonsillectomy method with significantly reduced blood loss and reduced surgical time and without any increase in the postoperative pain. It was a useful method for tonsillectomy.

OBJECTIVE: In this study, we analyzed the pathologic changes in the middle ear mucosa after the insertion of preserved allograft teeth in guinea pigs by examining serial sections under the light microscope.MATERIALS AND METHODS: Sixteen pigmented guinea pigs were included in this 2-stage study. In the first stage, 2 guinea pigs were killed, and a preservation technique that included autoclave sterilization was applied to their teeth. The proximal 3 quadrants of the dentition, including the root and pulpa, were separated from the distal quadrant, (approximately 1 mm3). In the second stage, a fragment was placed in the middle ear mucosa of the 12 remaining guinea pigs. The guinea pigs were coupled randomly, and was sacrificed sequentially on study days 3, 5, 10, 20, 40, and 60. The temporal bones were excised, and sections were obtained. The preparations were stained with hematoxylin-eosin and were analyzed under the light microscope.RESULTS: Although the pathologic changes surrounding the teeth were concordant with acute inflammation on the third and fifth postsurgical days, evidence of chronic inflammation was first noted on the 10th day after surgery. That inflammation subsided on the 20th day, and a fibroepithelial capsule encircled the teeth. Assessments on the 40th and 60th postsurgical days revealed that the inflammation was progressively resolving.CONCLUSION: The middle ear mucosa did not reject the preserved allograft teeth; instead, the implants were accepted as autologous tissue. No formation of new bones or resorption occurred during the brief follow-up period.

Objectives:We compared the effectiveness of acyclovir, hyperbaric oxygen (HBO) therapy with steroid and steroid therapy alone in the treatment of sudden sensorineural hearing loss (SSHL).Materials and Methods:36 patients diagnosed as SSHL between October 1997 and October 2001 at Dr. Lütfi K›rdar Kartal Training and Research Hospital were included in this study. Acyclovir therapy was given to 12 patients who had upper respiratory tract infections during the last week since viral infections were thought to be the possible etiologic factor. 12 of the remaining 24 patients received HBO therapy with steroids, while 12 patients were under steroid therapy alone. Hearing levels were evaluated by audiologic investigations before and after the treatment. The hearing levels at every frequency and so the hearing gain have been evaluated and compared between the groups.Results:Higher hearing levels were obtained with treatment at all frequencies except 250, 4000 and 8000 Hz in steroid group, whereas in acyclovir and HBO with steroid groups higher hearing levels were detected at all frequencies. Hearing gain was also higher in HBO group and acyclovir group than the steroid group.Conclusion:If there is an upper respiratory tract infection in the history of SSHL, acyclovir therapy can be advised, whereas in idiopathic group HBO with steroids can be recommended instead of steroid therapy alone.