Cem Uzun

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.

A tympanometric comparison of tympanoplasty with cartilage palisades or fascia after surgery for tensa cholesteatoma in children

Objective: The aim of the present study is to compare the tympanometric and functional findings of cartilage palisade tympanoplasty with those of tympanoplasty with temporalis fascia grafting after one‐stage surgery in children with tensa cholesteatoma. Study Design: In children aged 5 to 15 years (mean, 9.5 years) with tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. Tympanometry was performed in 31 ears with cartilage palisade tympanoplasty (the palisade group) and 28 ears with fascia tympanoplasty (the fascia group) at follow‐up a median of 48 months after surgical removal of the cholesteatoma (range, 3‐75 months). Main Outcome Measures: Postoperative perforations, tympanometric parameters (tympanogram type, compliance, tympanometric width), and hearing. Results: All postoperative re‐perforations occurred in the fascia group. However, there was no difference between the palisade group and the fascia group in terms of tympanometric parameters, nor between the two groups when dividing into tensa retraction and sinus cholesteatoma subgroups. When comparing the types of tympanoplasty, the type II group reconstructed with cartilage palisades contained a higher number of ears with a normal compliance (0.2‐1.6 mL) but a higher number of ears with a tympanometric width of more than 150 mmH2O. Regarding the number of ears with normal tympanometries, there was no significant difference between the palisade and the fascia group. The late functional hearing results were better in ears reconstructed with cartilage palisades, with functional success in 71%, compared with 54% in the group with fascia grafting. This difference in functional results was particularly pronounced in ears with an abnormal tympanogram (68% vs. 29%). Conclusion: Compared to fascia grafting, the present study showed better late functional hearing results after drum reconstruction using cartilage palisades, despite comparable tympanometric findings. Cartilage palisade reconstruction seems to provide better functional results, especially in ears with a poor tubal function, which is the common situation after cholesteatoma surgery.

Unusual complication of tonsillectomy: taste disturbance and the lingual branch of the glossopharyngeal nerve.

Taste disturbance is an unusual complication of tonsillectomy of which there are very few reports in the literature. The possible causes of this rare complication are: (1) direct or indirect damage to the glossopharyngeal nerve or its lingual branch (LBGN), (2) lack of dietary zinc, and (3) habitual drug intake. We report a 41-year-old man, who complained of taste disturbance following tonsillectomy that was performed for chronic tonsillitis and unilateral (left) tonsillar hypertrophy. During surgery, hypertrophic tonsils were found to be sited deeply into the tonsillar bed, especially at the lower pole of the left tonsil. Pathologic examination following tonsillectomy revealed a keratinous cyst and chronic infection at the left tonsil, and lymphoid hyperplasia and chronic infection at the right tonsil. Although his complaint had been getting better, qualitative examination of his taste function revealed bilateral impairment of the sense of sweet taste on the base of his tongue two months after the surgery, and a taste disturbance of sweet taste on the left side persisted the 10th month after the surgery. His serum zinc value was normal, and he did not take any drug that could affect his sense of taste. Depending on the literature data, possible indirect damage to the LBGN was suspected as the cause of the taste disturbance. This symptom may be reversible within two years after tonsillectomy, but it can also be irreversible. Therefore, tonsillectomy should be performed with minimal trauma to the tonsillar bed, especially when there is an additional pathology extending into the lower pole, and such a patient should be informed of the risk of post-operative taste disturbance after tonsillectomy as being one of the rare complications of this surgery.

Phlebectasia of left anterior jugular vein

We present a rare case of unilateral phlebectasia of the anterior jugular vein in a 56-year-old male patient whose complaint is a neck swelling that appears during talking. Although in this age group the most common cause of such a mass in the anterior aspect of the neck increasing in size during any type of straining or Valsalva manoeuvre is a laryngocele, phlebectasia of the anterior jugular vein should be considered in the differential diagnosis. Doppler ultrasound and computed tomography are the most useful and non-invasive methods to use for the investigation. Treatment should be conservative.

Eustachian tube patency and function in tympanoplasty with cartilage palisades or fascia after cholesteatoma surgery.

Objective: To compare the Eustachian tube patency and function after tympanoplasty with either cartilage palisades or fascia grafting after one-stage surgery in children with tensa cholesteatoma. Study Design: In children operated for tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. The patency of the Eustachian tube was evaluated by the Valsalva maneuver before the operation, 1 to 3 months after the operation, and at a follow-up examination 46½ months later (median). Eustachian tube function was evaluated by the nine-step inflation/deflation tympanometric test and the Toynbee test at the follow-up examination. Otomicroscopy and hearing evaluation were performed before and after surgery as well as at the follow-up. Main Outcome Measures: Eustachian tube patency and function. Hearing, postoperative eardrum perforation/retraction, and cholesteatoma recurrence. Results: The Valsalva maneuver was positive in 30% of the ears before the operation, in 65% primarily after the operation, and in 78% at the follow-up examination. A poor tubal function was found in 57% at follow-up. Overall, the late functional hearing results were better in ears with a positive Valsalva maneuver. There were no differences in tubal patency or function in relation to graft material, cholesteatoma, and tympanoplasty type. In ears with a poor tubal function, the hearing results were significantly better in the palisade group (63% success), compared with the fascia group (17% success). All of the four perforations, most of the retractions, and a single moist eardrum were found in the fascia group at the reevaluation. We found no correlation between the condition of the eardrum and the Eustachian tube function at the last evaluation. However, in ears with a poor tubal function, a nonretracted, nonperforated drum was found with higher frequency in the palisade group. Decision matrix analysis showed that the last postoperative Valsalva maneuver was the best predictor of the drum condition at the reevaluation. Conclusions: The Eustachian tube patency frequently improves after tympanoplasty after cholesteatoma surgery in children, regardless of graft material. The patency and function of the Eustachian tube seem to be without relation to graft material, cholesteatoma, or tympanoplasty type. Cartilage palisade tympanoplasty may be a better reconstruction technique after cholesteatoma surgery, especially in ears with a poor tubal function.

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.

Evaluation of predive parameters related to eustachian tube dysfunction for symptomatic middle ear barotrauma in divers.

Objective: Eustachian tube dysfunction plays an important role in the pathogenesis of middle ear barotrauma. This investigation evaluates the predictive value of several parameters related to tubal dysfunction, in relation to symptomatic middle ear barotrauma in divers. Study Design: Prospective and blinded. Patients: Thirty-one sport scuba divers with normal predive audiometry, tympanometry, and general and otorhinolaryngologic examination. Methods: After an occurrence of middle ear barotrauma, the individual diver predive data on smoking, mild septal deviation, otitis media history, rhinosinusitis history, Valsalva, Toynbee, and nine-step inflation/deflation tympanometric test, as well as degree of mastoid pneumatization were registered for calculation of predictive value in relation to the barotrauma. All symptomatic ears were examined within 24 hours of diving by the investigator, who was blinded to the predive findings. Barotraumas that occurred during an upper respiratory tract infection were excluded. Results: Divers completed a total of 774 dives (median, 25; range, 3-100). Symptomatic middle ear barotrauma occurred in 19 ears (31%) of 14 divers (45%) at one time or another. The rate of tubal dysfunction measured by the nine-step test and a mastoid pneumatization below average were significantly higher in divers (p < 0.05) as well as in ears (p < 0.005) with barotrauma. Positive and negative predictive values of both parameters for subsequent barotrauma were between 69% and 76%. Combining the results into a two-test battery in a strict approach (positive on both) increased the positive predictive value to 86%. Conclusion: Eustachian tube dysfunction measured by the nine-step test and a small size of the mastoid cell system seem to be risk factors for symptomatic middle ear barotrauma in otherwise healthy sport scuba divers. Evaluation of these factors in the predive examination of diving candidates may be useful in the determination of fitness to dive.

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.