Abdullah Tas

Evaluation of hearing in children with autism by using TEOAE and ABR

Assessment of auditory abilities is important in the diagnosis and treatment of children with autism. The aim was to evaluate hearing objectively by using transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR). Tests were performed on 30 children with autism and 15 typically developing children, following otomicroscopy and tympanometry. The children with autism were sedated before the tests. Positive emissions and normal hearing level at ABR were obtained in both ears of all children in the control group and of 25 children with autism. TEOAE and ABR results varied in the remaining five children with autism. The mean III–V interpeak latencies (IPLs) in both ears of children with autism were longer than those in the control group. Hearing loss may be more common in children with autism than in typically developing children.

Supracricoid partial laryngectomy with cricohyoidopexy and cricohyoidoepiglottopexy: functional and oncological results

Sixty-eight patients who presented with glottic and glottosupraglottic squamous cell carcinoma and who were managed in this department with supracricoid partial laryngectomy (SCPL) with either cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP), were retrospectively reviewed. The authors analysed the functional and oncological results of the patients. The median follow-up period was 62 months. The average times until decannulation and nasogastric feeding tube removal were 27.7 and 26.4 days, respectively. All patients were successfully decannulated. All patients were able to swallow, but one patient was unable to swallow and had recurrent aspiration. Better functional results were achieved in patients managed with CHEP procedure than the patients managed with CHP procedure. The five-year absolute and cause-specific actuarial survival rates (Kaplan-Meier method) were 78.6 per cent and 93.9 per cent, respectively. The five-year actuarial local control and nodal control rates were 89.5 per cent and 90.4 per cent, respectively. Local recurrence was statistically more likely in patients with positive resection margins (p <0.006). Overall, local control and laryngeal preservation were achieved in 95.6 per cent and 89.7 per cent, respectively. Supracricoid partial laryngectomy procedures (CHEP and CHP) are possible alternatives to total laryngectomy in the treatment of selected advanced glottic and glottosupraglottic carcinomas.

Use of the nine-step inflation/deflation test as a predictor of middle ear barotrauma in sports scuba divers.

Abstract Middle ear (ME) barotrauma, the most common disorder encountered in diving, results from inadequate pressure equilibration between the ME and the ambient environment. Eustachian tube function plays a key role in the pathogenesis of barotrauma. This study was designed to investigate the predictive value and efficiency of tympanometric tests of Eustachian tube function (Valsalva test, Toynbee test and nine-step inflation/deflation test) in predicting ME barotrauma in 44 ears of 22 sports scuba divers who had normal audiometry, tympanometry and otorhinolaryngological examination without previous history of ear disease. The divers were counselled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by one investigator who was unaware of the pre-symptomatic test results. Decision matrix analysis was applied to the results of Eustachian tube function tests for predicting ears with barotrauma. Values were also evaluated for a battery of tests by ‘Lax’ (positive on A, B or C) and ‘Strict’ (positive on A, B and C) criteria. The nine-step test was found to be the most efficient (93%) test with highest predictive values (PPV 83%; NPV 95%), whereas the Valsalva and Toynbee tests were unreliable in predicting barotrauma, whereas the Valsalva and Toynbee tests were unreliable in predicting barotrauma (PPV of the Valsalva and Toynbee tests were 0% and 25% respectively). Combining the nine-step and Toynbee tests into a two-test battery in a strict approach increased the PPV (100%). It appears that the nine-step inflation/deflation test is a reliable method of predicting ME barotrauma sufferers, especially when applied with the Toynbee test. The nine-step test may have value in the evaluation of Eustachian tube function of sports scuba diving candidates after routine otorhinolaryngological, audiological and tympanometric evaluation.

Use of Mometasone Furoate Aqueous Nasal Spray in the Treatment of Rhinitis Medicamentosa: An Experimental Study:

OBJECTIVE: We aimed to investigate, histopathologic changes in the nasal mucosa of guinea pigs after prolonged administration of oxymetazoline and the development of rhinitis medicamentosa, and the efficacy of mometasone furoate aqueous nasal spray and saline in reversing the ultrastructural changes attributable to rhinitis medicamentosa. METHODS: In the study, 24 male guinea pigs (500 to 600 gr) were used. Oxymetazolin (0.05%) was sprayed into the nasal cavities of the guinea pigs 3 times daily for 8 weeks. At the end of this period, 6 guinea pigs were killed and examined to make sure that the animals had developed rhinitis medicamentosa. The remaining guinea pigs were randomly divided into 3 groups. In the first group, one spray-puff of 0.05% mometasone furoate aqueous nasal spray (50 μg) was applied twice daily for 14 days. In the second group, saline solution (0.9% NaCl) was applied twice daily for 14 days. No treatment was performed in the third group. At the end of the treatment period, nasal mucosal changes were evaluated by light microscopy and electron microscopy. RESULTS: After oxymetazolin application for 8 weeks, the main histologic changes were edema, congestion, proliferation of subepithelial glands, and squamous cell metaplasia. After topical mometasone furoate aqueous spray application for 2 weeks, the edema fluid was found to diminish markedly. In the saline and no treatment groups, edema and congestion continued. In these groups of guinea pigs, fibrosis has been seen in the nasal mucosa. CONCLUSION: We found that mometasone furoate nasal spray was effective against experimentally induced rhinitis medicamentosa in guinea pigs. Mometasone furoate nasal spray may have value in the treatment of patients with rhinitis medicamentosa.

Influence of anaesthetic agents on transient evoked otoacoustic emissions and stapedius reflex thresholds.

This aim of this study was to determine the effect of anaesthetic agents on stapedius reflex (SR) thresholds and transient evoked otoacoustic emissions (TEOAE). Fifty patients who were scheduled for operation and who had normal hearing were included in the study. All were given midazolam for premedication and propofol for induction. Anaesthesia was maintained in five different ways in each group of 10 patients. Groups I-IV received inhalational anaesthesia: group I received 70 per cent N2O plus 30 per cent O2, group II sevoflurane, group III desflurane and group IV halothane. Group V received total intravenous anaesthesia with propofol plus sufentanil. The SR and TEOAE of the patients were measured four times: on the day before surgery (first measurement), after premedication (second measurement), after induction of anaesthesia (third measurement) and during maintenance of anaesthesia (fourth measurement). Midazolam significantly increased ipsilateral and contralateral SR thresholds and decreased TEOAE wave reproducibility. Propofol significantly increased only the SR thresholds. The other anaesthetic agents significantly increased only the contralateral reflex thresholds. Of these, the highest increase was seen after sevoflurane and the lowest after halothane. The changes in TEOAE wave reproducibility due to anaesthetic agents used for maintenance were not significant. We concluded that midazolam premedication may affect audiological evaluation with SR and TEOAE tests, and sevoflurane should not be used when it is necessary to measure SR under general anaesthesia.

Thyroglossal duct cyst in hyoid bone: unusual location.

An atypically sited thyroglossal cyst in a 69-year-old woman is described in this report. The cysts may be located in the intralingual, suprahyoid, thyrohyoid or suprasternal region. The intrahyoid location is rare. The diagnosis was confirmed by computed tomography (CT). Surgical procedure should be indicated in intrahyoid thyroglossal duct cyst cases.

Otoacoustic emissions in young adults with a history of otitis media

The aim of this study was to investigate otoacoustic emissions in young adults who had a history of otitis media (OM) in childhood and to assess whether a history of OM had an irreversible effect on hearing. We studied 116 cases between 15 and 25 years of age, divided into three groups. Each subject underwent a single examination comprising otoscopy, pure-tone audiometry (PTA), tympanometry, and transient evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) testing. Subjects in the first and second groups had normal audiometric hearing thresholds and type A tympanograms. The only difference between the first and second group was the presence or absence of a history of OM. The third group consisted of patients diagnosed as having active OM; these patients had poorer hearing thresholds and type B or C tympanograms. After statistical analysis of TEOAE and DPOAE results (one-way analysis of variance test), significant differences were noted between groups. Otoacoustic emission levels were, unsurprisingly, lowest in the third group, as expected. However, the most striking result in the study was that significantly fewer otoacoustic emissions were detected in subjects with a history of OM than in subjects without a history of OM. These findings suggest that OM in childhood may cause minor but irreversible damage to the middle ear or cochlea. Otoacoustic emissions testing can be used to detect this sub-clinical damage.

Alternobaric vertigo in sport SCUBA divers and the risk factors

We investigated the eustachian tube function and the incidence of alternobaric vertigo (AV) in 29 sport self-contained underwater breathing apparatus (SCUBA) divers with, or without, some possible risk factors for AV. The divers had normal audiological and otoscopic findings at the pre-dive examination. We used the nine-step inflation/deflation tympanometric test and Toynbee test for evaluation of eustachian tube function, and the Valsalva manoeuvre for patency. Information on divers, their history, and their otolaryngologic examination were obtained in the pre-dive examination. Divers performed 1086 dives (mean 37, range: 3-100) during the observation period. Four divers (14 per cent) experienced AV during five dives (0.46 per cent), (one diver experienced AV two times). It was found that having an otitis media history or eustachian tube dysfunction determined with the nine-step inflation/deflation tympanometric test before diving, or difficulty in clearing ears during diving could be important risk factors for AV in sport SCUBA divers (p <.05). Divers with such findings seem to be more prone to AV and should pay rigorous attention to the precautions for prevention of AV.

Thyroid gland tuberculosis with endolaryngeal extension: a case with laryngotracheal dyspnoea.

Tuberculosis affecting the thyroid gland is a rare condition. We present the case of a 30-year-old man with thyroid tuberculosis whose presenting complaints were dyspnoea and hoarseness. There was a cystic mass in the posterosuperior right thyroid lobe extending into the paraglottic space. There was also recurrent laryngeal nerve involvement. We performed surgery and administered post-operative antituberculous treatment.

Possible Ototoxic Effects of Topical Rifamycin Application: An Electrophysiological and Ultrastructural Study

Objective This study aimed to investigate possible ototoxicity associated with topical rifamycin application via electrophysiological tests and ultrastructural examinations. Methods Electrophysiological assessment was performed with tympanometry, auditory brainstem response (ABR), and distortion product otoacoustic emission (DPOAE) measurements. This study was conducted on 40 ears of 20 guinea pigs that were detected to have normal hearing thresholds. The animals were randomly assigned to three groups: Group 1 (n=12) received 0.1 mL rifamycin, Group 2 (n=8) received 0.1 ml gentamycin, and Group 3 (n=20) received 0.1 mL physiological saline. The antibiotics and saline solutions were administered via intratympanic injections. After five injections every other day, electrophysiological tests were performed again on the 15th day. After electrophysiological measurements, the temporal bones of all guinea pigs were prepared for ultrastructural examinations and the cochlear surface morphology was examined by scanning electron microscopy (SEM). Results The animals in group 3 did not show a statistically significant change in their DPOAE signal/noise ratio (SNR) or ABR thresholds (p>0.05). In groups 1 and 2, the reduction in the DPOAE SNR and the increase in the ABR threshold were statistically significant (p<0.05). Regarding SEM examination results, the animals in groups 1 and 2 showed statistically significant outer hair cell damage and cochlear degeneration due to the ototoxic effect of the drugs (p<0.05), whereas the animals in group 3 showed no significant damage (p>0.05). Conclusion The results indicate that rifamycin application to the middle ears of guinea pigs has mild ototoxic effects on their inner ears.