Cem Bilgen

A nasopharyngeal mass: leech in the nasopharynx.

This paper presents a case with a 4-month history of nasal obstruction and intermittent epistaxis. The cause was found to be a leech in the nasopharynx by means of endoscopic examination. Leech endoparasitism, although rare, may cause serious, even lethal, complications. A high index of suspicion of leech infestation must be entertained when faced with nasal obstruction and intermittent epistaxis in children, and should be investigated surgically as with all other foreign bodies.

Short-Term Effects of Vestibular Rehabilitation in Patients With Chronic Unilateral Vestibular Dysfunction: A Randomized Controlled Study

OBJECTIVE To evaluate the short-term effects of vestibular rehabilitation on symptom, disability, balance, and postural stability in patients with chronic unilateral vestibular dysfunction. DESIGN Randomized controlled trial. SETTING Department of Physical Medicine and Rehabilitation, University Hospital. PARTICIPANTS Patients (N=42) with chronic vestibular dysfunction were divided into either a rehabilitation group (group 1) or a control group (group 2). INTERVENTIONS Patients in group 1 were treated with a customized exercise program for 4 weeks, while the patients in the control group did not receive any treatment. MAIN OUTCOME MEASURES Subjects were assessed before and after the rehabilitation program with respect to symptoms (visual analog scale [VAS]), disability (Dizziness Handicap Inventory [DHI]), balance (Berg Balance Scale [BBS]), and postural stability (modified Clinical Test for Sensory Interaction on Balance [mCTSIB]). RESULTS Significant improvements in all parameters (VAS, DHI, BBS, mCTSIB) were observed in group 1 (P<.05). When the 2 groups were compared, there were significant improvements in postexercise VAS, DHI (emotional, functional, physical, total), BBS, and mCTSIB (standing on a firm surface with eyes open, standing on a foam surface with eyes open, standing on a foam surface with eyes closed, mCTSIB mean) in favor of group 1 (P<.05). No significant improvements were seen in any parameters in the control group (P>.05). CONCLUSIONS Significant improvements were seen in symptom, disability, balance, and postural stability in chronic unilateral vestibular dysfunction after an exercise program. Customized exercise programs are beneficial in treatment of chronic unilateral vestibular dysfunction.

CT imaging of superior semicircular canal dehiscence: added value of reformatted images.

Abstract Conclusion: Superior semicircular canal dehiscence (SSCD) syndrome may present with various symptoms. CT scans previously interpreted as normal may show SSCD, especially if special reconstructions tailored for superior canal evaluation are added. Objectives: The purpose of this study was to investigate prevalence of SSCD, its length and its correlation with symptoms in patients who had previously undergone temporal bone CT examination that was reported normal and to demonstrate the importance of reformatted images in the diagnosis of SSCD. Methods: We retrospectively reviewed 108 patients who had undergone temporal bone CT examination for various symptoms and were reported as normal. High-resolution temporal bone CT imaging was performed with 1 mm slice thickness in the transverse plane. Each of the superior semicircular canals was evaluated in the plane of Pöschl and Stenver reformatted images together with axial images. Results: Ninety-three patients were included in the study. Nineteen patients with semicircular canal dehiscence were detected. The mean age of the study group was 45 years. Radiologic evidence of SSCD occurred in 23 of 186 temporal bones with a radiologic prevalence of 12%. The most common symptoms in dehiscent patients were vertigo, hearing loss and tinnitus. Defect lengths varied between 1 mm and 6.5 mm.

Adherence to continuous positive airway pressure therapy in obstructive sleep apnea syndrome: effect of visual education

BackgroundContinuous positive airway pressure (CPAP) therapy is the most effective treatment in obstructive sleep apnea syndrome (OSAS) although it is known that adherence to therapy is limited. The aims of this study were to evaluate the effect of visual education on CPAP adherence and to identify the factors affecting adherence.MethodsOut of 133 consecutive newly diagnosed moderate-to-severe OSAS patients, 66 were informed about OSAS and CPAP therapy and received visual education by videotape (video group), whereas only information was given to 67 of them (control group). The patients were followed up in the 1st, 3rd, and 6th months.ResultsAfter 6-month follow-up, adherence rate to CPAP therapy was 71.2% in the video group and 56.7% in the control group (p = 0.08). OSAS symptoms, such as witnessed apnea, morning headache, night sweating, dry mouth, and Epworth sleepiness score (ESS), were ameliorated more significantly in the video group (p < 0.05). In order to assess predictors of adherence, 85 patients using CPAP effectively were compared to 48 nonadherent patients; significant improvement in OSAS symptoms and ESS was observed in the adherent patients (p < 0.05). ESS was negatively correlated with the duration of CPAP use (r = −0.524, p < 0.0001). Adverse effects such as mask intolerance, choking, noise, and nasal congestion were related to poorer adherence (p < 0.01).ConclusionsIt is shown that adherence rate to CPAP therapy might be improved by visual education although the difference was not significant. Besides, patients with better adherence to CPAP treatment report the greatest improvement in OSAS symptoms and daytime sleepiness, and adverse effects are significantly related to poorer adherence.

Clinical assessment of topiramate therapy in patients with migrainous vertigo.

(Headache 2010;50:77‐84)

Jugular Bulb Diverticula: Clinical and Radiologic Aspects

OBJECTIVE: This study was performed to determine the clinical presentation of jugular diverticulum and its relevance with the extension of the lesion. STUDY DESIGN: The records and high-resolution CT scans of 1474 patients, with otologic symptoms or related clinical findings, were evaluated retrospectively. In 17 cases in which CT scans revealed the presence of jugular diverticulum, sensorineural symptoms were evaluated with respect to a reference line, perpendicular to the basal turn of the cochlea and tangent to the vestibule in axial CT scan images. RESULTS: When the extension of jugular diverticulum was posterior to the reference line, sensorineural symptoms with vertigo were dominant in most patients (72.7%) in this group. On the other hand, for the patients with anterior-extending jugular diverticulum, sensorineural symptoms without vertigo were detected in 50% of patients, whereas 33.3% had sensorineural symptoms with vertigo. CONCLUSION: This study revealed a relationship between the extension of jugular diverticulum and clinical symptoms. However, this relationship lacks statistical evidence because of the limited number of patients.

Single-shot, low-dose intratympanic gentamicin in Ménière disease: role of vestibular-evoked myogenic potentials and caloric test in the prediction of outcome.

OBJECTIVE The aim of this study was to assess the efficacy and safety of single and low-dose intratympanic gentamicin therapy in patients with Ménière disease and who were monitored both with caloric tests and vestibular-evoked myogenic potentials (VEMPs) to see if VEMPs have an additional role in predicting the efficacy of the drug. STUDY DESIGN This is a prospective cohort study. SETTING Tertiary referral center is the study setting. PATIENTS Twenty-five intractable Ménière disease patients were included as the study group. INTERVENTION(S) Low-dose (16 mg/mL), single-shot intratympanic gentamicin was applied. VEMP and caloric test were applied 2 weeks after the application. MAIN OUTCOME MEASURE(S) Safety and efficacy of protocol were evaluated at the sixth month postoperatively with tonal audiogram and visual analog scale, respectively. RESULTS Mean average pure-tone hearing threshold at 0.5, 1, 2, 4, and 8 kHz was 49.6 and 51.0 dB before and after the application, respectively (P > .05). Mean pretreatment and posttreatment visual analog scale scores of patients were 17.6 mm (10-30 mm) and 74.6 mm (41-100 mm), respectively (P < .01). Posttreatment VEMPs were absent in 17, deteriorated in 2, and not changed in 6 patients. VEMP was a significant predictor of posttreatment visual analog scale score, whereas caloric test was not (P < .01). CONCLUSIONS Low-dose, single-shot intratympanic gentamicin treatment proved to be effective and safe among intractable Ménière patients. VEMPs obtained at posttreatment second week were significant predictors of patients posttreatment sixth-month dizziness status and vertigo control.

Pre-emptive Effects of Ibuprofen Syrup and Lidocaine Infiltration on Postoperative Analgesia in Children Undergoing Adenotonsillectomy

We aimed to compare the effects of lidocaine and adrenaline with ibuprofen syrup (administered before adenotonsillectomy) on post-operative analgesia and initiation of oral feeding. One group of 20 children received 100 g/5 ml ibuprofen suspension (10 mg/kg) 1 h before anaesthesia; bleeding control was provided by pre-incisional administration of 1:200000 adrenaline solution (10 ml). The same amount of 0.5% lidocaine solution plus 1:200000 adrenaline was applied pre-incisionally in a similar manner in a second group of 20 children. No significant differences were observed between the two groups in terms of the duration of operation and anaesthesia, post-operative pain scores, paracetamol requirements, times to initiation of liquid and solid food intake, or adverse side-effects. We conclude that ibuprofen syrup applied pre-incisionally and local infiltration with lidocaine are equally effective for post-operative analgesia.

Middle ear impedance measurements in large vestibular aqueduct syndrome

OBJECTIVE To assess the effect of inner ear pressure on middle ear impedance in patients with large vestibular aqueduct syndrome (LVAS). METHODS Data from admittance tympanometry and multifrequency tympanometry on 8 LVAS patients and control subjects were studied. RESULTS Static acoustic compliance (SAC) values for the ears with stable sensorineural hearing loss (SNHL) were within the limits of the mean values of control groups except for two ears. The resonance frequency (RF) values of the ears with stable SNHL were lower than the mean values of control groups except for three ears. SAC values for the two ears with fluctuating SNHL were lower and the RF values were higher than the mean values of control groups. CONCLUSION Decreased SAC values and increased RF values found in the ears with fluctuating SNHL might be an indirect indicator of increased inner ear pressure, while low RF values in the ears with stable SNHL might reflect the decreased inner ear impedance.

A Clinical Prediction Formula for Apnea-Hypopnea Index

Objectives. There are many studies regarding unnecessary polysomnography (PSG) when obstructive sleep apnea syndrome (OSAS) is suspected. In order to reduce unnecessary PSG, this study aims to predict the apnea-hypopnea index (AHI) via simple clinical data for patients who complain of OSAS symptoms. Method. Demographic, anthropometric, physical examination and laboratory data of a total of 390 patients (290 men, average age 50 ± 11) who were subject to diagnostic PSG were obtained and evaluated retrospectively. The relationship between these data and the PSG results was analyzed. A multivariate linear regression analysis was performed step by step to identify independent AHI predictors. Results. Useful parameters were found in this analysis in terms of body mass index (BMI), waist circumference (WC), neck circumference (NC), oxygen saturation measured by pulse oximetry (SpO2), and tonsil size (TS) to predict the AHI. The formula derived from these parameters was the predicted AHI = (0.797 × BMI) + (2.286 × NC) − (1.272 × SpO2) + (5.114 × TS) + (0.314 × WC). Conclusion. This study showed a strong correlation between AHI score and indicators of obesity. This formula, in terms of predicting the AHI for patients who complain about snoring, witnessed apneas, and excessive daytime sleepiness, may be used to predict OSAS prior to PSG and prevent unnecessary PSG.