Engin Dursun

Follow-up results of 415 patients after endoscopic sinus surgery

Abstract Endoscopic sinus surgery (ESS) is a method used with success in the treatment of chronic inflammatory paranasal sinus diseases. Between February 1991 and June 1995 the Messerklinger technique for ESS was used in 415 patients who had been pre-operatively evaluated in detail according to the staging system used in our clinic. Average post-operative follow-up was 23 months. Our general success rate was found to be 86.3% upon evaluating the subjective improvements in the patients’ symptoms in the post-operative period. The major and minor complication rates in our series were 0.24 and 20.24%, respectively.

Endoscopic butterfly cartilage myringoplasty

Abstract Conclusion: Based on the results of this study, it is believed that, in appropriate patients with tympanic membrane perforation, the endoscopic butterfly cartilage myringoplasty can be applied, with a shorter operation time, high graft success rate, and low risk of complications. Objective: The aim of this study was to evaluate the results of the endoscopic butterfly cartilage myringoplasty in terms of the graft success rate and hearing gain. Methods: Forty-five ears of the 42 patients who were subjected to endoscopic butterfly cartilage myringoplasty surgery between January 2013 and December 2014 were included in this study. The archival records of the patients were reviewed retrospectively, evaluating the pre-operative and post-operative hearing results and post-operative graft success rates in the early and late periods. Results: The graft success rates were 97.8% (44/45 ears) and 95.6% (43/45 ears) at the post-operative 1- and 6-month follow-ups, respectively. When the post-operative air conduction hearing thresholds were compared, significant improvement was seen at post-operative 1- and 6-month follow-ups in the hearing thresholds, when compared to the pre-operative levels (p < 0.001).

The Prevalence of Aspirin Hypersensitivity in Patients with Nasal Polyposis and Contributing Factors

Background Aspirin (acetylsalicylic acid [ASA]) hypersensitivity is frequent in patients with nasal polyps (NPs) and is called aspirin exacerbated respiratory disease, previously known as Samters syndrome. However, studies evaluating the prevalence of ASA hypersensitivity in patients with NPs using the oral aspirin provocation test (APT) are quite limited. This study was designed to determine the prevalence of ASA hypersensitivity and factors associated with ASA hypersensitivity in patients with NPs. Methods Sixty-eight patients with NPs with or without asthma were recruited. Extension of NPs was evaluated by endoscopic examination/paranasal CT. A 2-day, single-blind placebo-controlled APT was used to detect ASA hypersensitivity. Results APT was performed in 53 (21 women/ 32 men) patients (mean age, 39.34 ± 1.76 years). APT resulted positive in 12 patients (22.6%) of whom 3 (25%) had no history of ASA hypersensitivity. Of the positive APTs, three were isolated rhinitis and nine had classic responses. APT was negative in 41 patients (77.4%) although three (7.3%) had a history of ASA hypersensitivity. History of ASA hypersensitivity and prolonged duration of NPs were associated with positive APT (p < 0.05). Advanced NP with multiple operations was also correlated with APT positivity but was not statistically significant. Presence of asthma was associated with age, female gender, NP duration, and ASA hypersensitivity history (p < 0.05), but not with smoking, atopy, NP extension, and positive APT. Conclusion ASA hypersensitivity is quite common in patients with NP. Patients with extensive and long-term NP with multiple polyp operations require evaluation for the presence of ASA hypersensitivity in terms of chronic management and future risks of the disease.

Do single-photon emission computerized tomography findings predict severity of chronic rhinosinusitis: a pilot study.

Background Chronic rhinosinusitis (CRS) is basically an inflammatory disease of the mucosa and periosteum of the sinuses. The possibility of local osteitis can cause persistent mucosal inflammation and lead to failure of treatment. Bone scintigraphy is the gold standard procedure for detecting the bone involvement. This study was designed to evaluate whether single-photon emission computerized tomography (SPECT) findings predict severity of chronic sinusitis and subjective response to medical treatment. A prospective case control study was done. Methods Twenty-four patients with CRS were involved. SPECT findings for bone involvement and computed tomography-based staging (limited disease, stage 1; extensive disease, stages 2 and 3) were compared. These data were also analyzed in terms of subjective response to medical treatment and prognosis. Results SPECT uptakes were positive in 79.2% (19/24) and negative in 20.8% (5/24) of the patients. SPECT was positive in 4/8 of the patients with limited disease and 15/16 of the patients with extensive disease. In subjective assessment of medical treatment 5/8 of the limited disease versus 1/16 the extensive disease patients had good response; whereas 5/5 of SPECT− patients versus 1/19 of SPECT+ patients had good response. Conclusion Bone SPECT results were found to be correlated with the stage of CRS. Poorer subjective response was observed in patients with positive SPECT.

A comparison of spiral and conventional computerized tomography methods in diagnosing various laryngeal lesions

Abstract Although endoscopic procedures with tissue biopsy are the mainstay in the evaluation of laryngeal lesions, radiological imaging studies remain important. Computerized tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) are the most reliable methods, especially for deep laryngeal compartments, cartilage, extralaryngeal structures and neck nodes. However, the larynx is a difficult organ for radiological imaging because respiration and swallowing can cause several artifacts and distort image. In this report we studied the role of a spiral CT technique and compared this with conventional CT in 32 patients. We used the Hitachi W950SRBT machine and took both conventional and spiral sections of the larynx and neck in all 32 patients. The scans were taken with a 5-mm table motion and 5-mm section thickness in both studies. In the spiral technique the raw data acquired were used retrospectively for 2-mm and 5-mm reconstructions. Anatomic details, motion artifacts and vascular enhancements were compared by a scoring system. The mean values were then analyzed statistically by the paired t-test. The average examination time was 3 min 18 s for conventional CT and 28 s for spiral CT. Anatomic detail scores were better in the 2-mm section spiral CT studies compared to 5-mm section spiral and conventional CT groups. Motion artifact scores were better in the 2-mm and 5-mm spiral CT groups compared to the 5-mm conventional CT group. Vascular enhancement scores were better in the spiral CT group. Overall, the thinner (2-mm) sections of the spiral CT studies further improved image quality regarding both anatomic details and motion artifacts. Scanning time for spiral CT was very short, motion artifacts were less, and vascular enhancement and anatomic details were better. Volumetric data could also be reconstructed for thinner sections in all planes retrospectively for further evaluation. Our findings showed that spiral CT was a better method than conventional CT for evaluating laryngeal lesions.

Endoscopic cartilage tympanoplasty in chronic otitis media

OBJECTIVES The use of endoscopic techniques is becoming more widespread in otological and neuro-otological surgery. One such procedure, endoscopic tympanoplasty, is used in chronic otitis media treatment. This study aimed to analyse the results of endoscopic transcanal cartilage tympanoplasty. METHODS Data of tubotympanic chronic otitis media patients who underwent transcanal endoscopic type I cartilage tympanoplasty between June 2012 and May 2013 were analysed. The main outcome measures were graft success and hearing improvement. RESULTS Graft success rates were 94.3 per cent and 92.5 per cent at post-operative months one and six, respectively. Post-operative air-bone gap values were significantly improved over pre-operative values (p < 0.01). CONCLUSION Transcanal endoscopic type I cartilage tympanoplasty is a minimally invasive, effective and reliable surgical treatment option for chronic otitis media.

COULD HELICOBACTER PYLORI PLAY A ROLE IN THE AETIOPATHOGENESIS OF TYMPANOSCLEROSIS

AIM The aetiology of tympanosclerosis is not yet clear. This prospective, controlled, clinical study investigated the relationship between Helicobacter pylori and tympanosclerosis aetiology. MATERIALS AND METHODS The study included 14 patients with tympanosclerosis and 26 with other forms of chronic otitis media. All patients underwent surgery for chronic otitis media. Mucosal biopsies were taken, and examined for H pylori using the Campylobacter-Like Organism (CLO) test. RESULTS Tympanoplasty was performed in 29 patients (72.5 per cent), radical mastoidectomy in eight (20 per cent) and myringoplasty in three (7.5 per cent). The presence of H pylori was tested in all tympanosclerosis biopsies, but in only 26.9 per cent of biopsies from other forms of chronic otitis media. A statistically significant difference in H pylori presence was found (p ≤ 0.01). CONCLUSION This study represents a preliminary investigation of the association between H pylori and tympanosclerosis development.

An aberrant internal carotid artery in the temporal bone presenting as a middle-ear mass: a case report.

OBJECTIVE To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass. CASE A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach. CONCLUSION All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.

The evaluation of eustachian tube paratubal structures using magnetic resonance imaging in patients with chronic suppurative otitis media

Abstract Conclusion Eustachian tube (ET) dysfunction, which plays a role in the pathogenesis chronic suppurative otitis media (CSOM), does not seem to be due to differences in paratubal structures. Objective The aim of this study was to compare the magnetic resonance imaging (MRI) findings of the paratubal structures of the ET between normal ears and ears in patients with CSOM. Methods The MRI records of 40 patients who underwent tympanomastoidectomy for a diagnosis of CSOM were reviewed retrospectively. The healthy ears served as the control group. The length, diameter, surface area and volume of the tensor veli palatini muscle (TVPM) and levator veli palatini muscle (LVPM) were measured, in addition to the diameter of the pharyngeal orifice of the ET, volume of the Ostmann fat pad, bimucosal thickness of the lumen of the ET, and mucosal thickness. Results In the pathological ears, the mean length of the TVPM and LVPM was 22.6 mm and 19.3 mm, the mean diameter was 3.2 and 5.3 mm, and the mean volume was 1.75 and 3.2 cm3, respectively. In addition, the mean diameter of the pharyngeal orifice of the ET was 1.9 mm. There were no significant between-group differences in the paratubal structures (p > 0.05).

Diagnostic value of the wideband acoustic absorbance test in middle-ear effusion

OBJECTIVES This study aimed to investigate the diagnostic value of wideband acoustic absorbance testing in otitis media with effusion. METHODS This prospective study compared middle-ear wideband acoustic absorbance rates in three paediatric patient groups: a healthy group of 34 volunteers; 48 patients diagnosed with otitis media with effusion; and 28 patients with chronic effusion but no sign of effusion during myringotomy. The diagnostic value of absorbance testing was analysed with the receiver operating characteristic test. RESULTS The wideband acoustic absorbance rate was significantly lower in the otitis media with effusion group than in both the otitis media and healthy groups at the 0.375-2 kHz averaged mean absorbance (p < 0.017 and p < 0.001, respectively). Receiver operating characteristic analysis showed the highest diagnostic value for the 0.375-2 kHz averaged mean (area under the curve 0.984), followed by those at 1 and 1.5 kHz (area under the curve: 0.973 and 0.967, respectively). CONCLUSION The wideband acoustic absorbance test is more accurate for detecting middle-ear effusion compared with conventional 226-Hz tympanometry. Its practicality and objectivity suggest that the wideband acoustic absorbance test may be a better alternative for diagnosing otitis media with effusion.