Babur Akkuzu

Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere’s disease

The objective was to investigate vestibular evoked myogenic potentials (VEMP) in benign paroxysmal positional vertigo (BPPV) and Meniere’s disease, and to determine if this type of testing is valuable for assessing the vestibular system. A prospective controlled clinical study was designed in a tertiary referral center setting. The 62 participants included 17 healthy controls and 45 other subjects selected from patients who presented with the complaint of vertigo (25 diagnosed with BPPV and 20 diagnosed with Meniere’s disease). The main outcome measures of VEMP were recorded in all subjects and findings in each patient group were compared with control findings. The VEMP for the 30 affected ears in the 25 BPPV patients revealed prolonged latencies in eight ears and decreased amplitude in one ear (nine abnormal ears; 30% of total). The recordings for the 20 affected ears in the Meniere’s disease patients revealed four ears with no response, six ears with prolonged latencies (ten abnormal ears; 50% of total). Only two (5.9%) of the 34 control ears had abnormal VEMP. The rate of VEMP abnormalities in the control ears was significantly lower than the corresponding rates in the affected BPPV ears and the affected Meniere’s ears that were studied (P=0.012 and P<0.001, respectively). The results suggest that testing of VEMP is a promising method for diagnosing and following patients with BPPV paroxysmal positional vertigo and Meniere’s disease. Further investigations with this method in other neurotologic pathologies might also be informative.

Six cases of Forestier syndrome, a rare cause of dysphagia

Abstract Dysphagia is a common presenting complaint in otolaryngology practice, and there are many causes. Forestier syndrome is a rare cause of dysphagia. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) syndrome or vertebral ankylosing hyperostosis. Forestier syndrome consists of anterolateral perivertebral ligament calcification. It was first described by Forestier and Rotes-Querol in 1950; diagnosis is primarily radiological and the etiology is unknown. In addition to dysphagia Forestier syndrome has been reported to cause laryngeal stridor, dyspnea, snoring and hoarseness. Other important symptoms associated with Forestier syndrome are stiffhess and pain in the back, pain related to tendinitis, myelopathy related to core compression associated with the ossification of the posterior longitudinal ligament, and pain related to vertebral complications such as fracture or subluxation. We report six cases of Forestier syndrome as an etiologic factor in dysphagia and present clinical and radiological findings.

Misoprostol in the treatment of tinnitus: a double-blind study

OBJECTIVE: To test the efficacy of misoprostol as a treatment for tinnitus. DESIGN: A prospective, placebo-controlled, double-blind study. SETTING: Başkent University Otolaryngology Clinic. PATIENTS: Forty adult patients who had had tinnitus for a minimum of 6 months and were free of systemic or otolaryngologic disease. Twenty-eight patients were randomly assigned to the experimental group (group I) and 12 to the control group (group II). INTERVENTION: The respective groups received active drug and placebo in increasing doses for 4 months. The effect of medications on tinnitus were evaluated by determining improvement rates in tinnitus loudness and subjective tinnitus scoring. RESULTS: In the experimental group, 18 of 28 patients showed improvement in tinnitus loudness, representing an improvement rate of 64%. The improvement rate based on subjective tinnitus scoring was 36% (10 of 28 patients). In the control group, the improvement rate for tinnitus loudness was 33% (n = 4), and the rate for subjective tinnitus scoring was 17% (n = 2). The difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.039), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.119). When results in the experimental group were analyzed according to etiological factors, the improvement rate was highest in the sudden-onset subgroup (77%). CONCLUSIONS: Misoprostol provided therapeutic relief for some patients with tinnitus we studied, but further investigation of larger groups is needed. (Otolaryngol Head Neck Surg 2004;130:604-10.)

Nasal myiasis by fruit fly larvae: a case report

We report a case of human nasal myiasis caused by fruit fly larvae in a 33-year-old man who visited the south coast of Turkey. The fruit fly (Drosophila melanogaster) is endemic in the southern part of Turkey. Infestation with fruit fly larvae must be considered in patients who are visiting areas of the world where Drosophila is endemic. This is the first reported case of fruit fly larvae causing human nasal myiasis. The clinical presentation and treatment strategies are discussed.

Congenital partial arhinia: a case report

Congenital arhinia is an extremely rare anomaly consisting of an absence of external nasal structures and nasal passages. Fewer than 30 cases have been reported. Patients with a familial absence of the nose have been reported, but the effects of genetic and maternal factors are unknown. Midface hypoplasia may accompany arhinia. Accompanying malformations are thought to be caused by an absent or rudimentary nose. A patient with partial congenital arhinia is presented and the embryology and literature review are discussed.

Comparison of nasal region dimensions in bilateral choanal atresia patients and normal controls: A computed tomographic analysis with clinical implications

OBJECTIVE To determine if any difference exists between a set of nasal dimension measurements in choanal atresia patients and in a control group. METHODS A retrospective study was undertaken to define the variation of values for a series of nasal dimension measurements through axial computed tomography in 9 patients with bilateral choanal atresia and compare the same dimensions with a control group 104 patients of similar gender and age distribution. The statistical significance of the differences in these dimensions was examined. RESULTS Nine of 17 variables showed a significant difference between normal and choanal atresia group. The result showed that the growth of the nasal complex can be influenced by nasal obstruction. CONCLUSION These findings might serve in understanding the differential growth patterns of nasal structures in the face of the nasal breathing obstruction. Computed tomography is valuable in defining the exact anatomical extent of the disease and also in preoperative evaluation of the patient.

Bullous pemphigoid associated with parotid carcinoma

The presence of various cutaneous disorders may reflect the occult internal malignancy.1 Bullous pemphigoid (BP) is an acquired, autoimmune, subepidermal blistering disease of the skin. Many reports in the literature have suggested that there is a relationship between BP and internal malignancy.2,3 We describe the case of a patient with paraneoplastic BP associated with carcinoma of the parotid gland. To our knowledge, this type of tumor has not previously been reported in association with BP.

Tortuous internal carotid artery indenting the piriform sinus: a case report

A case of tortuous internal carotid artery bulging and partially obliterating the piriform sinus, causing a sensation of fullness and abnormal throat, accompanied by choking spells in a 57-year-old patient is presented. Endoscopic examination and computerized tomographic angiography were useful in establishing the diagnosis. This rare anomaly should be recognized in order to prevent possible fatal hemorrhages during further surgical interventions of the piriform sinus.

Frontal mucocele with an accompanying orbital abscess mimicking a fronto-orbital mucocele: case report

BackgroundMucoceles are slowly expanding cystic lesions with respiratory epithelium containing mucus most commonly affecting the frontal and ethmoidal sinuses. They are caused by obstruction of sinus ostium. Mucoceles exert pressure on the bony boundaries and due to the proximity to the brain and orbit extension to these areas are common.Case presentationA case of a frontal mucocele with an accompanying orbital abscess mimicking a fronto-orbital mucocele is reported. A 77 year old female patient suffering from left sided proptosis and pain around the left eye was admitted to our department. She had a history of left frontal sinus mucocele one year ago that was offered an osteoplastic frontal sinus surgery that the patient refused. Patient had limitation of eye movements. Fundoscopic examination revealed a minimal papilledema. Coronal computerized tomography and orbital magnetic resonance imaging showed a frontal mucocele with suspicious erosion of the orbital roof and a superiorly localized extraconal mass displacing the orbit lateroinferiorly. Frontal and orbital masses had similar intensities. Thus surgery was planned for a fronto-orbital mucocele. During surgery no defect was found on the orbital roof. Frontal mucocele and orbital cystic mass was removed separately. Pathological examination showed a frontal mucocele and an orbital abscess wall. Postoperatively eye movements returned to normal and papilledema resolved.ConclusionFronto-orbital mucoceles are commonly encountered pathologies, but frontal mucocele with an orbital abscess is a rarely seen and should be kept in mind because their treatments differ.

Risk of contamination of nasal sprays in otolaryngologic practice

BackgroundReusable nasal-spray devices are frequently used in otolaryngologic examinations, and there is an increasing concern about the risk of cross-contamination from these devices. The aim of our study was to determine, by means of microbiologic analysis, the safety of a positive-displacement or pump-type atomizer after multiple uses.MethodsA reusable nasal spray bottle, pump, and tips were used in the nasal physical examination of 282 patients admitted to a tertiary otolaryngology clinic. The effectiveness of 2 different methods of prophylaxis against microbiologic contamination (the use of protective punched caps or rinsing the bottle tip with alcohol) was compared with that of a control procedure.ResultsAlthough there was no statistically significant difference in positive culture rates among the types of nasal spray bottles tested, methicillin-resistant coagulase-negative staphylococci were isolated in 4 of 198 cultures.ConclusionGiven these findings, we concluded that additional precautions (such as the use of an autoclave between sprays, disposable tips, or disposable devices) are warranted to avoid interpatient cross-contamination from a reusable nasal spray device.