Bayram Veyseller

Does the addition of hyperbaric oxygen therapy to the conventional treatment modalities influence the outcome of sudden deafness

OBJECTIVE : To investigate the therapeutic effects of the addition of hyperbaric oxygen (HBO) therapy to the conventional therapies in sudden deafness (SD) and to investigate the influence of patient age on the effectiveness of HBO therapy. STUDY DESIGN AND SETTING : We undertook a retrospective review of 50 cases of SD treated at a tertiary university hospital. Twenty-five patients (group 1) were treated with betahistine hydrochloride, prednisone, and daily stellate ganglion block. A second group (group 2) of 25 patients received the same basic treatment with the addition of HBO therapy. RESULTS : The mean hearing gain was 20.0 dB in group 1 and 37.9 dB in group 2 (P < 0.05). In group 2 patients, the mean gains were 51.4 and 23.3 dB for those younger and older than 50 years (P < 0.05) and 48.9 and 14.5 dB for those younger and older than 60 years (P < 0.001), respectively. In patients older than 60 years, the mean gains were 14.5 and 14.4 dB in group 2 and group 1, respectively (P > 0.05). CONCLUSIONS : The addition of HBO therapy to the conventional treatment significantly improves the outcome of SD, especially in patients younger than 50 years. Additional HBO therapy provides limited benefit in patients older than 50 years and no benefit in patients older than 60 years.

Midterm outcomes of outfracture of the inferior turbinate.

OBJECTIVE: A variety of medical and surgical treatment alternatives exists for the management of inferior turbinate hypertrophy, indicating a lack of consensus on the optimal technique. The purpose of the present study was to evaluate the inferior turbinate objectively by means of radiologic methodology during the early and late periods in patients treated with inferior turbinate outfracture. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Eighty inferior turbinates of 40 patients (28 males, 12 females) who underwent surgery because of septum deviation and inferior turbinate hypertrophy were included in this prospective clinical study. All patients were evaluated by paranasal sinus computed tomography preoperatively and at one and six months postsurgery. The angle and the distance between the inferior turbinate and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone were measured on the coronal plane anterior posteriorly at five different anatomic levels. RESULTS: Statistically significant reductions were noted in the angle and distances in all sections one and six months postoperatively when compared with the preoperative measurements (P < 0.005). CONCLUSION: Compared with the preoperative status, those patients who underwent turbinate outfracture procedures displayed a reduction in the angle and the distance between the inferior turbinate bone and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone one month following surgery. Ongoing outcomes of this treatment method have been objectively shown.

Medical treatment of adenoid hypertrophy with "fluticasone propionate nasal drops".

BACKGROUND Adenoid hypertrophy treatment for children is generally planned in accordance with the degree of airway obstruction and related morbidity. If surgical treatment is indicated, the individual risk/benefit analysis of patients should be assessed in terms of anesthetic and postoperative complications. Although there are few alternative treatment options, these may be considered as a nonsurgical approach in less serious cases. Accordingly, studies about intranasal steroid applications under various protocols have been presented. STUDY DESIGN The prospective, randomized, placebo-controlled study. SETTING Tertiary referral center. PATIENTS AND METHODS Patients indicated for surgery were randomly divided into two groups. The study group was treated by fluticasone propionate nasal drops (NSD-nasal steroid drops) of 400 microg/day for 8 weeks. The control group was treated by normal saline (NS) in the same way. All the patients were called for follow-up every 4 weeks. RESULTS At the end of 8 weeks, statistically significant improvement (p<0.05) was observed in the NSD treated group compared to the NS treated group in terms of nasal airway obstruction, mouth breathing, speech abnormalities, apnea and night cough. At the end of 8 weeks, the average total symptoms score of the NSD treated group dropped from 13.7 to 2.9 while the NS treated groups score changed from 14.8 to 14.6. After 8 weeks of NSD treatment the initial adenoid/choana (A/C) rate had dropped from 87 to 56% and a total decrease of 35.6% was observed. After 8 weeks of NS treatment the A/C rate dropped from 87 to 85% and a total decrease of 2.2% was observed. CONCLUSIONS In this study, the effect of fluticasone propionate nasal drops on adenoid hypertrophy is examined for the first time. This method provides an effective alternative to surgical treatment in children with adenoid hypertrophy. With the protocol applied in this study 76% of the patients were eliminated the surgery and removed from the surgical waiting list.

Effect of Recurrent Laryngeal Nerve Identification Technique in Thyroidectomy on Recurrent Laryngeal Nerve Paralysis and Hypoparathyroidism

OBJECTIVE To investigate whether the recurrent laryngeal nerve (RLN) identification technique used in thyroidectomy affects RLN paralysis and hypoparathyroidism. DESIGN Patients were allocated into 2 groups according to the thyroidectomy technique used to identify the RLN: (1) superior-inferior direction, exploring the nerve where it enters the larynx, followed by superior pedicle ligation; and (2) inferior-superior direction, following the inferior pedicle ligation and identifying the nerve in the tracheoesophageal groove. The first and second groups included 67 and 128 patients, respectively. In the first group, 19 patients underwent lobo-isthmectomy, and 48 underwent total thyroidectomy. In the second group, 42 patients underwent lobo-isthmectomy, and 86 underwent total thyroidectomy. We performed 115 and 214 RLN dissections in the first and second groups, respectively. SETTING Academic tertiary hospital. PATIENTS The study included 195 consecutive patients, 161 female (82.5%), and 34 male (17.5%), who underwent thyroidectomy for goiter between January 2006 and August 2009. Their mean age was 44.7 years (range, 14-79 years). The mean follow-up was 26 months (range, 12-42 months). INTERVENTIONS Unilateral or bilateral total thyroidectomies performed using extracapsular dissection with 2 different RLN identification techniques. MAIN OUTCOME MEASURES Incidence of hypocalcemia, vocal cord paralysis, hemorrhage, and wound infection. RESULTS No RLN paralysis was observed in the first group. In the second group, unilateral RLN paralysis was seen in 2 of 128 patients (1.5%). Groups 1 and 2 included 48 and 86 total thyroidectomies, respectively. Temporary hypoparathyroidism was observed in 4 patients in the first group (8.3%). In the second group, permanent hypoparathyroidism was observed only in 4 patients (4.6%), and temporary hypoparathyroidism was observed in 14 patients (16.2%). CONCLUSIONS Comparing the 2 groups based on the frequencies of RLN paralysis and hypoparathyroidism, we found that complications were significantly lower in the first group (P < .05) in terms of hypoparathyroidism. The rate of hypoparathyroidism was significantly lower in the thyroidectomies that located the RLN using the superior-inferior approach. In our hands, the superior-inferior approach was a safer technique, in terms of avoiding complications.

Role of nasal muscles in nasal valve collapse

Objective: This study was performed to determine the role of nasal muscle function in patients with dynamic or static nasal valve collapse by comparing the electromyographic activities of nasal muscles in healthy individuals. Study Design: Cross-sectional clinical study. Setting: Tertiary referral center. Subjects and Methods: Twenty adult patients with dynamic nasal valve collapse, 18 patients with unilateral static nasal valve stenosis (septum deviation), and 20 healthy adults were included in the study. The activity of their nasal muscles was measured by surface electromyography (EMG), and the results were compared for the patient and control groups. Results: No abnormal finding was found in any of the nasal muscles of the control group. In the majority of patients with dynamic nasal valve pathology, statistically significant functional disorders were detected in the m dilator naris anterior and m nasalis transversalis muscles compared with the controls. During inspiration and expiration in patients with static nasal valve pathology, some revealed muscular abnormities during inspiration. Normal muscle activation was observed in all of the patients during expiration. Conclusion: Determination of agents involved in pathologies of the nasal valve region is necessary for planning appropriate treatment. The role of nasal muscles in dynamic nasal valve pathologies, which has not been previously recognized, should be considered. A more effective and adequate solution for the nasal sidewalls than static pathologies should be considered in these patients by taking into account the muscular activity disorders detected by EMG at the stage of surgical treatment.

Relationship of olfactory function with olfactory bulbus volume, disease duration and Unified Parkinson’s disease rating scale scores in patients with early stage of idiopathic Parkinson’s disease

We aimed to investigate the relationship between olfactory function and olfactory bulbus (OB) volume, disease duration and Unified Parkinsons disease rating scale (UPDRS) scores in early stage idiopathic Parkinsons disease patients. The University of Pennsylvania Smell Identification Test (UPSIT) was used for the evaluation of olfactory function. UPSIT scores for patients with Parkinsons disease were significantly lower than controls. There was no significant difference between stage 1 and stage 2 patients. OB volumes were higher in stage 1 and 2 patients than controls, but there was no statistical difference between the three groups. No significant correlation was found between UPSIT and UPDRS total scores, nor between UPSIT scores and disease duration in stage 1 and 2 patients. According to our results, we propose UPSIT be used as a screening test to diagnose presymptomatic patients, but not OB volumes.

Reduced olfactory bulb volume and diminished olfactory function in total laryngectomy patients: a prospective longitudinal study.

Background This study was designed to investigate the effects of total laryngectomy on olfactory bulb (OB) volume and olfactory function prospectively. A prospective, longitudinal, randomized study was performed. Methods Fifteen subjects with advanced cancer of the larynx were recruited. The OB volume was measured preoperatively and 6 months postoperatively using magnetic resonance imaging (MRI) and olfactory function was assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) test. A detailed otorhinolaryngological examination was conducted and abnormalities that could potentially cause olfactory dysfunction were excluded. An experienced radiologist segmented the MRI coronal slices manually for OB volume measurements. Results The difference between the right and left OB volumes was not significant. OB volume decreased significantly 6 months postoperatively, from 64.2 to 47.1 mm3 (p < 0.001). The CCCRC test results, scored out of 8, decreased significantly from 5.6 to 2.4 (p < 0.001) and all patients were either anosmic or hyposmic. Conclusion This longitudinal prospective study was the first to examine the cessation of olfactory stimulation in olfactory deficiency resulting from OB functional and structural changes.

Endoscopic Transcanal Inlay Myringoplasty: Alternative Approach for Anterior Perforations.

M ost failures of myringoplasty during the repair of tympanic membrane perforations (TMPs) occur when the tear is located in the anterior half of the membrane. In describing the outcomes of 1040 myringoplasties, Nardone et al reported that anterior localization negatively affected operative success. If the entire perforation is not visible in a single field, either a postauricular approach must be used, or canalplasty must be performed to expose the entire perforation. Both alternatives are associated with longer operative times than that of myringoplasty, and the postoperative recovery period is longer. Various surgical approaches and techniques have been attempted to overcome the issues associated with anterior TMP repair. Here, we introduce an alternative approach for the closure of anterior TMPs up to 5.5 mm in diameter, and we present our clinical results.

Reduced olfactory bulb volume in total laryngectomy patients: a magnetic resonance imaging study.

OBJECTIVES The olfactory bulb (OB) is a remarkably plastic structure with highly active afferent neurons, which is partly reflected by its volume. Although deterioration of olfaction after total laryngectomy is reported by many patients, this problem has not received widespread attention. There has been no study that had addresses this loss olfactory ability as a function of OB volume. The aim of this study was to determine OB volume changes after laryngectomy. STUDY DESIGN Twenty one patients post-total laryngectomy and 17 subjects with normal olfactory function underwent magnetic resonance imaging (MRI) for volumetric measurement of the OB. The history of all participants was taken in detail to exclude other possible causes of smell dysfunction. Volumetric measurement of the OB was performed by manual segmentation of the OB into coronal slices. Olfactory function was assessed with the orthonasal olfaction test. RESULTS There was no statistically significant difference in volume between the right and left sides of the OB in the study and control groups. However, the study group had smaller OB volumes than the control group. In our assessment of orthonasal olfaction, patients who were post-total laryngectomy had worse orthonasal olfactory function than the control group. There were significant correlations between OB volumes and orthonasal test scores. CONCLUSIONS Our MRI study showed that post-total laryngectomy patients had higher rates of olfactory bulb atrophy than the control subjects. Laryngectomy is associated with measurable decreases in olfactory function and this study hopes to further clarify this association by demonstrating that patients with total laryngectomy have reduced OB volumes when compared to the normal population.

Effect of Postrhinoplasty Taping on Postoperative Edema and Nasal Draping: A Randomized Clinical Trial

BACKGROUND Edema persists for months after rhinoplasty. Numerous modalities have been described to counteract postoperative edema. OBJECTIVE To evaluate the effect of postrhinoplasty taping (PRT) on nasal edema and nasal draping. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, 57 patients undergoing rhinoplasty at a tertiary reference center from August 1, 2014, to January 31, 2015, were assigned to a control group or to 2- or 4-week PRT groups. Baseline nasal thickness was measured with ultrasonography at the nasion, rhinion, supratip, and tip, and mean nasal skin thickness (MNST) was calculated. Participants in each group were categorized by the baseline MNST measurement from the lowest to greatest MNST; those in the upper half were categorized as having thick skin; those in the lower half, thin skin. The control group underwent no PRT after the removal of external packing. Patients in the 2- and 4-week PRT groups received additional taping during the allocated time. Data were collected from August 1, 2014, to June 31, 2015. Follow-up was completed on June 31, 2015, and data were analyzed from July 1 to August 1, 2015. MAIN OUTCOMES AND MEASURES Postoperative measurements of MNST were performed at the end of weeks 1, 3, and 5 and month 6. RESULTS Of the 57 total patients (33 male and 24 female patients; mean [SD] age, 30.0 [11.7] years), 17 were in the 2-week PRT group; 20, the 4-week PRT group; and 20, the control group. Compared with the control group, 4-week PRT had a significant effect on the supratip (P = .001). Comparisons of MNST with the control group revealed significant effects of 2-week (P = .02) and 4-week (P = .007) PRT. The effect on the tip was not significant (P = .052). Postrhinoplasty taping had no effect in thin-skinned patients. Comparison among thick-skinned patients revealed a significant effect on the MNST (P = .01) and the rhinion (P = .02) but not the tip (P = .06) and supratip (P = .07). CONCLUSIONS AND RELEVANCE Postrhinoplasty taping helps the skin envelope to compress to the underlying framework and decrease postoperative edema. The procedure can be used particularly in thick-skinned patients, in whom skin draping and nasal refinement is crucial to the surgical outcome. LEVEL OF EVIDENCE 1. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02626585.