Erkan Karatas

Audiovestibular disturbance in patients with systemic lupus erythematosus

OBJECTIVE: The aim of this study was to evaluate the audiovestibular disturbance in patients with systemic lupus erythematosus (SLE). STUDY DESIGN AND SETTING: Twenty-eight patients with SLE and 28 healthy control subjects were included. Pure-tone audiometry, impedance audiometry, and electronystagmography (ENG) were used for baseline evaluation. Laboratory tests were carried out. Cranial and brain stem magnetic resonance imagings (MRI) were undertaken. RESULTS: Nineteen (67%) patients reported audiovestibular symptoms. Sensorineural hearing loss was found in 6 (21%) patients. Abnormal results on ENG were significantly higher (50%) (P < 0.01). Abnormal laboratory data were available from 26 patients (P < 0.05). MRI did not show any pathosis. CONCLUSION: The audiovestibular disturbances in SLE are more prevalent than previously recognized. Although no cause and effect relationship can be established by this type of study, it appears that a relationship exists. SIGNIFICANCE: Audiologic research should be directed toward routine, pure tone audiometry, and ENG assessment for patients with SLE to enable crucial treatment.

Immunohistochemical Analysis of PCNA, Ki67 and p53 in Nasal Polyposis and Sinonasal Inverted Papillomas

Immunoreactivity of proliferating cell nuclear antigen (PCNA), Ki67 and p53 in inflammatory nasal polyp and inverted papilloma tissues was investigated. Immunohistochemistry was performed using a standard avidin–biotin–peroxidase method, and the immuno-reactivity of PCNA, Ki67 and p53 was quantified by counting immunostained nuclei in at least 1000 epithelial cells. The mean labelling index (percentage of immunostained cells) for PCNA was 40.68 in the inverted papilloma group and 14.73 in the nasal polyp group, and for Ki67 was 15.43 in the inverted papilloma group and 2.64 in the nasal polyp group. Both of these differences between the inverted papilloma and nasal polyp groups were significant. Immunoreactivity for p53 was detected in five (35.7%) inverted papilloma patients and two (9.5%) nasal polyp patients. The increase in epithelial cell proliferation seemed to be greater in inverted papillomas than in inflammatory nasal polyps. Increased epithelial cell proliferation may be involved in the development of inverted papillomas.

Contralateral Normal Ear after Mastoid Surgery: Evaluation by Otoacoustic Emissions (Mastoid Drilling and Hearing Loss)

Mastoid drilling can cause transient hearing loss in the contralateral normal hearing ear. A study was designed to evaluate hearing in the contralateral normal ear before and after the mastoid surgery in a longitudinal manner and find out the duration of this temporary hearing loss. Twenty-two patients requiring mastoid surgery in their diseased ears, having contralateral normal ear were included. Pure tone audiometry and otoacoustic emissions (OAEs) were utilized for baseline evaluation. OAEs were repeated during the immediate postoperative period and daily up to the 6th postoperative day. The amplitudes of the OAEs of contralateral normal ears were found affected immediately after surgery and progressive improvement was detected with full recovery at 72–96 h. None of the patients had permanent deterioration in OAE amplitudes. The burs used during mastoid surgery can cause temporary hearing threshold changes in the contralateral ears. This adverse effect recovers spontaneously within 72–96 h postoperatively.

Incudostapedial Rebridging Ossiculoplasty with Bone Cement

OBJECTIVE: The purpose of this study is to evaluate hearing results of our experience with ionomeric bone cement repair of ossicular discontinuity between incus and stapes. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: One hundred thirty-six patients who underwent incudostapedial rebridging ossiculoplasty with ionomeric bone cement were included in the study. Preoperative and postoperative audiologic results of incudostapedial rebridging ossiculoplasty with bone cement were evaluated. One year of follow-up is provided. RESULTS: The postoperative air-bone gap was less than 20 dB in 81.6 percent after one year. The mean preoperative and postoperative pure-tone avarages of the patients were 52.82 ± 5.59 and 32.81 ± 7.18 dB, respectively (P < 0.01). The mean preoperative and postoperative air-bone gaps were 35.83 ± 4.73 and 16.54 ± 5.01, respectively (P < 0.01). There were no statistically significant differences among the hearing results of different types of surgeries (P >0.05). No complications in the middle ear related to bone cements were encountered. CONCLUSIONS: Incudostapedial rebridging ossiculoplasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.

Does dexmedetomidine affect intraoperative blood loss and clotting tests in pediatric adenotonsillectomy patients

BACKGROUNDnWe hypothesize that dexmedetomidine (DEX), a selective α(2) adrenergic receptor agonist, may affect the intraoperative blood loss and clotting tests such as prothrombin time, activated partial thromboplastin time, and international normalized ratio in children undergoing adenotonsillectomy (ADT).nnnMETHODSnSixty patients scheduled for elective ADT under general anesthesia. The patients were randomly assigned to receive either DEX 0.5 μg/kg (group D) or placebo bolus (group C) with a total volume of 10 mL, 10 min before the induction of anesthesia. Mean arterial pressure (MAP), heart rate, blood loss, preoperatively and immediately after awakening clotting tests, agitation, sedation, visual analog scale, and analgesic requirement, were assessed and recorded.nnnRESULTSnThe postoperative hemoglobin was significantly lower than the preoperative value in both groups (P < 0.05). The postoperative agitation scale and analgesic requirement and visual analog scale at the 15th min were significantly lower in group D than those in group C (Pxa0< 0.05). Total blood loss and postoperative sedation score in group D was significantly higher than that in group C (P < 0.05). The postoperative prothrombin time, activated partial thromboplastin time, international normalized ratio tests between the groups, additionally pre-postoperative MAP, heart rate, and clotting tests were similar in each group.nnnCONCLUSIONSnThe premedication with DEX 0.5 μg/kg decreased postoperative agitation, pain, and analgesic requirement without significant change in the clotting tests and MAP but increased bleeding slightly during ADT.

Evaluation of Hearing Loss after Spinal Anesthesia with Otoacoustic Emissions

The aim of this study was to determine the degree and reversibility of hearing loss (HL) following spinal anesthesia with an objective audiometric test: otoacoustic emissions (OAE). Eleven patients (22 ears) who were undergoing surgery under spinal anesthesia were included in this study. Transient-evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE) were evaluated 1xa0day before the operation and postoperative day 1, 2, and 15. DPOAE were recorded as DPgram and input/output functions (I/O). The emission amplitudes of the TEOAE and DPOAE of right and left ears were found to be affected immediately after the surgery and progressive improvement detected with full recovery within postoperative 15xa0days. These changes were mainly at around 1,500–3,000xa0Hz. None of the patients had permanent OAE amplitude deterioration. Transient HL may occur more often than it is generally assumed, and the symptoms might not be recognized. OAE is an effective and objective way of evaluating the HL in this particular group of patients. We suggest informing patients about this transient HL for medicolegal issues.

Comparison of the coaxial circle circuit with the conventional circle circuit.

OBJECTIVEnThe coaxial circle system helps prevent heat loss during surgery, and it also acts as a humidifier. This study aimed to compare the coaxial breathing system and the conventional system in their ability to warm and moisturize inhaled gases, and we also analyzed lung function protection and saccharin clearance time in patients who underwent tympanomastoidectomy (TMT) with the aid of these two systems.nnnMATERIALS AND METHODSnForty adult patients of ASA physical status I-II were scheduled for elective TMT. A standard volume-dependent ventilator setting was used to establish normocapnia. The coaxial circle system was used in the treated group (n=20), whereas the conventional circuit system was used in the control group (n=20). Saccharin clearance, VC (vital capacity), FRC (functional residual capacity), FEV1 (forced expiratory volume in 1 second), airway pressure, relative humidity and temperature of inspired gas, body temperature and adverse and hemodynamic effects were measured at different perioperative periods.nnnRESULTSnThe relative humidity (mg H2O Lt -1) of inspired gas in the treated group was higher than in the control group at 5, 15, 30, 45, 60 and 90 minutes after anesthesia induction. The temperature of inspired gas (Centigrade) in the treated group was higher than in the control group (p<0.05) after 5, 10, 15, 30, 45, and 90 minutes of anesthesia. Postoperative saccharin clearance time was lower than before the operation in the treated group (p<0.05). Postoperative FRC was lower than preoperative FRC in the study and control groups (p<0.05).nnnCONCLUSIONnThe coaxial circle system decreased postoperative saccharin clearance time and increased postoperative FRC, relative humidity and the temperature of inspired fresh gas, without any adverse perioperative effects in patients who underwent TMT.