Duygu Erdem

Risk factors for otitis media effusion in children who have adenoid hypertrophia

OBJECTIVE Many studies have shown that children with adenoid hypertrophy (AH) are more likely to have chronic otitis media with effusion (COME). However, not every child with AH has COME. In this study, we investigated the socio-demographic risk factors of children who underwent surgery for AH, including a subgroup with COME. Our aim was to identify the factors involved in the development of COME. METHODS The study population consisted of 170 pediatric patients (118 males, 52 females) who underwent adenoidectomy between 2005 and 2008. The patients were divided into two groups, those with AH alone and those with AH and COME (AH+COME). Major factors such as age, gender, breast-milk feeding, bottle-feeding, tobacco smoke exposure, familial predisposition, allergies, congenital diseases, and school attendance were compared between the two groups. RESULTS AH alone was detected in 102 of the patients, 68% of whom were male, and AH+COME in the remaining 68, of whom 72% were male. The mean age was 6.5 years in the AH group and 5.3 years in the AH+COME group. There were no significant differences between the two groups with respect to breast-feeding, bottle-feeding, familial predisposition, tobacco exposure, and allergies. However, the relationships between COME and male sex, congenital diseases, and school attendance were significant. CONCLUSIONS COME is seen in young children with AH. Among the socio-demographic features examined in this study, only male sex, congenital diseases, and school attendance were statistically significant risk factors for COME development.

Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy

Objective To assess pretreatment levels in the counts and percentages of leukocytes and the neutrophil-lymphocyte ratio (NLR) in benign and malignant salivary gland tumors (SGTs) while investigating whether NLR is an inflammatory marker for distinguishing low- from high-grade parotid gland tumors. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods This study was performed on 182 patients with SGTs (age range: 16-87 years; 93 male and 89 female) who were treated between January 2010 and May 2015. Pretreatment counts and percentages of leukocytes and NLR were measured preoperatively in benign and malignant tumors. Results Mean neutrophil percentage (63.50% ± 12.11% vs 58.76% ± 8.20%, P = .008) and NLR (3.29 ± 3.13 vs 2.13 ± 1.26, P = .008) were significantly higher in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte count (2.42 ± 0.72 103/mm3 vs 1.97 ± 0.87 103/mm3, P < .001) and percentage (30.67% ± 7.68% vs 26.86% ± 10.15%, P = .011) were lower in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte percentage and NLR were significantly different between low- and high-grade malignant parotid gland tumors (P = .026 and P = .030, respectively). Conclusion Elevated NLR could be an inflammatory marker to distinguish low- from high-grade malignant parotid gland tumors.

Audiometric correlations with pathologies of ossicular chain in 159 ears with chronic otitis media

disorders. • Abnormal lateral canal function for high-frequency stimuli tested by vHIT was rare (8%) in vestibular migraine (VM), suggesting that there is a substantial remaining high-frequency canal function in VM. • In vestibular neuritis (VN), caloric and vHIT responses are more frequently affected than VM, with a significant positive correlation between both tests. • Caloric and vHIT probe different frequencies of head movement and provide complementary information regarding the lateral canal function.

The role of the nasal and paranasal sinus pathologies on the development of chronic otitis media and its subtypes: A computed tomography study

Objective: This objective of this study is to evaluate the presence and the coincidence of common nasal and paranasal sinus pathologies in adults suffering from chronic otitis media (COM) and its subtypes. Materials and Methods: The study group comprised 354 ears of 177 patients who underwent tympanoplasty with or without mastoidectomy from January 2013 to February 2015 due to uni/bilateral COM. Chronic suppurative otitis media, intratympanic tympanosclerosis (ITTS), cholesteatoma, and tympanic membrane with retraction pockets constituted subtypes of COM. The control group consisted of 100 ears of 50 adult patients with aural diseases other than middle ear problems. All patients were evaluated for the evidence of mucosal disease on paranasal sinuses, the presence of concha bullosa (CB), and the angle of nasal septal deviation (NSD) and thickness of the medial mucosa of the inferior turbinate were measured by coronal computed tomography images. Results: The incidence and the angle of NSD were found significantly higher in patients with COM (P = 0.028, P = 0.018; respectively). When ears with unilateral and bilateral COM compared in term of sinonasal pathologies, CB was found higher in patients with unilateral COM (P = 0.040). The presence of CB was significantly higher in ITTS when compared to other subtypes (P = 0.028). Conclusions: Our study suggests that obstructive nasal pathologies such as NSD and CB may play a role in the pathogenesis of especially unilateral COM. However, there was no correlation between COM and inflammatory pathologies such as sinusitis.

Does Type 2 Diabetes Mellitus Affect the Healing of Bell's Palsy in Adults?

OBJECTIVES Bells palsy (BP) is defined as an acute facial weakness of unknown cause. Many factors affecting the healing of BP have been identified; 1 factor commonly considered relevant is the presence of type 2 diabetes mellitus. Our aim was to investigate the effects of diabetes on the healing of BP. METHODS Sixty patients with BP were followed up for 1 to 3 years and were divided into 2 groups, those with and those without type 2 diabetes. All were prescribed prednisone (initially 1 mg/kg per day, with a tapered dose reduction) and acyclovir (200 mg orally every 4 h, 5 times daily, for 5 days). Their recovery times were compared. RESULTS The healing times of the patients with and without diabetes did not differ. CONCLUSIONS Diabetes does not affect the severity, recovery rate from or healing of BP.

Reply to the letter to the editor ''in response to: a better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials'' 10.1007/s00405-016-4019-0.

We have read Dr. Lou’s letter titled as ‘‘A better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials’’ with great pleasure [1]. Firstly we would like to make a short explanation about the technic used for the aspiration of the external ear canal in bacterial cellulose (BC) myringoplastia that we thought it was not fully understood [2]. We made a desepithelization to the perforation edges before the placement of the BC. This desepithelization process was applied in two ways: in some patients, medial and lateral layers of the tympanic membrane were separated, while in others, a millimetric piece of tissue was excised from the edges of the perforation. After that, a 1-mm expansion was detected in the perforation. Then, BC that is 2 mm wider than the perforation diameter was placed overlay. Millimetric pieces of spongostans were then placed over the BC. During the follow-up period, spongostans that are not melt away were aspirated. We should mention that we do not agree with the author’s opinion about the effects of desepithelization to the healing process of the tympanic membrane perforation. As all we know, the tympanic membrane consists of three layers. Outer layer is keratinized squamous epithelium, inner layer is non-keratinized mucosal epithelium, and middle layer is connective tissue. Epithelization occurs before fibrous tissue advancement in acute perforations (\3 months) [3], in which 81–96 % spontaneous closure rates have been reported [4, 5]. But, adversely, in chronic perforations, a contact inhibition occurs when outer layer epithelium and inner layer epithelium touch each other [6]. Our hypothesis is that contact inhibition causes an arrest in the epithelial proliferation, and connective tissue is coated with a solid epithelium. What we expect from an ideal graft material during wound healing in myringoplastia is to proliferate all three layers of the tympanic membrane. By desepithelization, firstly, the contact inhibition is eliminated, and additionally, release of growth factors, such as EGF and FGF, that cause an acute inflammation occurs. By this way, a contact of the connective tissue to the underlying fibrous tissue is provided. So, we think that the edge trimming (desepithelization) is an excellent method, and the development of new biocompatible materials reproduces the structure and mechanical properties. Currently, there are two approaches, such as surgical and tissue engineering, for myringoplastia. There is still no consensus on the optimal treatment for TM repair. Surgical technic has high success rates (with temporal muscle fascia, perichondrium and cartilage) however requires an additional incision for obtaining graft material and greater surgical time [7, 8]. Materials used for tissue engineering are biomolecules (growth factors as fibroblast growth factors, epidermal GF), cells and scaffold materials (decellularized tissue as a cellular collagen, alloderm and polymers as Gelfoam, silk fibroin, chitosan, sponges ex) [9, 10]. Another tissue engineering material that has been applied in vitro approaches is BC. Previously performed in vitro researches showed that BC has been shown to lead to proliferation in connective tissue of the This reply refers to the comment available at doi:10.1007/s00405-016-4019-0.

Recovery time for inflamed middle ear mucosa in chronic otitis media.

Abstract Conclusion: The present study shows that 2–3 weeks after medical treatment the status of middle ear mucosa in draining ears is similar to that of dry ears for at least 3 months. Objective: To measure the time required for an inflamed middle ear mucosa to return into optimal state after appropriate medical treatment in chronic suppurative otitis media (CSOM). To assess optimal timing for elective surgical treatment of draining ears in uncomplicated CSOM. Methods: In this prospective study, the Eustachian tube (ET) mucociliary clearance time (MCT) was used as the method to demonstrate the status of middle ear mucosa. In group 1 (28 patients) ET-MCT was measured in ears that were free of drainage for at least 3 months. In Group 2 (21 patients), ET-MCT was measured in draining ears, who responded to 10–14 days medical treatment, at presentation, after 10 days and 1 month. Results: The ET-MCT was 8.63 ± 1.32 min in group 1 and 28.96 ± 8.19 min in group 2 at presentation; and the difference was statistically significant (p < 0.001). The ET-MCT was 14.76 ± 5.11 min after 10 days and 9.31 ± 2.33 min after 1 month in group 2. The ET-MCT was indifferent between groups 1 and 2 after 1 month (p = 0.235).

Midface Osseous Dimensions are not Affected by Uncorrected Nasal Septal Deviation

Methods: The study included 150 patients (104 males, 46 females; 18-63 years) who had paranasal sinus CT. The study population consisted of 51 patients with anterior nasal septal deviation (NSD) (group I), 72 patients with posterior NSD (group II) and 27 patients with no NSD (group III). By using multiplanar reconstruction (MPR) technique, on coronal plane the width of PA (PAW), the right and left maxilla spinal length (RMSL and LMSL) and the angle of the septal deviation (ASD) and on sagittal plane the height of the PA (PAH), the UAFH and the LM were measured.