Hatice Celik

The impact of fixated glass ionomer cement and springy cortical bone incudostapedial joint reconstruction on hearing results.

Conclusions: Although it abolishes the incudostapedial joint, use of glass ionomer cement to repair the defect between the stapes head and the long process of the incus is a successful procedure when the hearing results are considered. Objectives: To compare the hearing results obtained by a fixed, stiff reconstruction with glass ionomer cement, and a flexible, springy pseudo-joint built with autologous cortical bone in patients with a small defect between the long process of the incus and the stapes head. Patients and methods: A total of 66 patients who had canal wall up tympanomastoidectomy due to chronic otitis media and incus long process defect between January 1996 and February 2008 were analyzed retrospectively. Their incudostapedial joints were reconstructed using either glass ionomer cement (n=31) or autologous cortical bone (n=35). Results: The mean follow-up period was 22.8 months for all cases. The mean postoperative air bone gap (ABG) was 29.2 dB and it reduced to 11.8 dB at the end of the follow-up period. Preoperative and postoperative ABGs were 27.4 dB and 10.6 dB in the glass ionomer cement group and 30.9 dB and 12.8 dB in the cortical bone group, respectively. The ABG closure was 16.8 dB in the glass ionomer cement group and 18 dB in the cortical bone group.

The functional and anatomical results of the canal wall down tympanoplasty in extensive cholesteatoma

Conclusion: Although we have shown that malleus handle and mucosal factors were important prognostic factors for hearing, we were unable to show the positive effect of the stapes superstructure on hearing results. The positive effect of the presence of the stapes superstructure on hearing results is closely related to the quality of the mucosa. Objective: The aim of this study was to investigate the impact of ossicular and mucosal factors on hearing in primary canal wall down (CWD) surgery with ossicular chain reconstruction (OCR) performed for extensive acquired cholesteatoma. Patients and methods: A total of 134 adults who had CWD surgery with OCR for extensive acquired cholesteatoma between January 1996 and May 2007 were retrospectively analyzed. Results: The graft insufficiency was 13%, chronic infection without cholesteatoma was 6% and cholesteatoma recurrence was 8% after the first operations. The rate of anatomic failure was 10% after a follow-up period of 46.3 months. In this study, we present the anatomic results for 136 ears and functional results for 135 ears. The hearing gain was significantly higher in the cholesteatoma-only group when compared with the mucosal–cholesteatoma disease group. Forty-three ears (54%) in the cholesteatoma-only group and 23 ears (42%) in the mucosal–cholesteatoma disease group had postoperative ABG within 20 dB. The best hearing results were obtained in Austin group B, while the worst hearing results were evident in Austin group C (p=0.017). Postoperative ABG was within 20 dB in 44% (n=31) of the patients with an intact stapes superstructure, while this ratio was 54% (n=35) when the stapes superstructure was absent.

Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index

PURPOSE The aims of this study were to investigate the prognostic impact of middle ear risk index on the postoperative hearing results in cases with type 2 ossiculoplasty; to compare the middle ear risk index results among primary, staged, and revision cases; and to compare the results of the prostheses used in ossicular reconstruction. MATERIAL AND METHODS Records of 293 patients who had canal wall up tympanomasteidectomy and type 2 ossiculoplasty due to chronic otitis media between November 1995 and November 2007 were reviewed retrospectively. RESULTS The mean preoperative air-bone gap was 32.6 dB, and it decreased to 15.2 dB after a mean follow-up period of 26.8 months postoperatively. The mean change of air-bone gap was 17.4 dB. Postoperative air-bone gap was 20 dB or less in 79% of the cases. The patients with dry perforations were in the low-risk group, and 91% of them had an air-bone gap of 20 dB or less. This value was 86% in the ones with intact malleus. The patients who had primary surgery were found in moderate risk group, whereas staged and revision groups were in the high-risk group. The air-bone gap was 20 dB or less in 84%, 78%, and 59%, respectively, of those groups. The difference between the primary and the revision groups reached a statistical significance. CONCLUSIONS We had the best ossicular reconstruction results with glass ionomer cement, whereas the worst results were obtained with allograft partial ossicular replacement prostheses. We determined that risk-reducing factors such as dry ear, minimal ossicular chain defect, and intact malleus were important to have successful results. The middle ear risk index is a valuable tool for the surgeon to judge the risks and the probability success of the procedure as well as to make a good patient selection.

Analysis of long-term hearing after tympanosclerosis with total/partial stapedectomy and prosthesis used

Conclusion. Long-term hearing gain results are good after prosthetic reconstruction of the stapes in the tympanosclerotic ear. The type of stapedectomy, whether partial or total, does not affect the result of the surgery very much. Objectives. Comparative evaluation of the hearing results of total/partial stapedectomy technique and the prosthesis used within a 10-year follow-up period after stapedectomy in cases with dense tympanosclerosis and completely fixed stapes. Patients and methods. Twenty-five cases with completely fixed stapes due to generalized tympanosclerosis were included in this retrospective study between 1995 and 2005. Two-stage canal wall up procedure was planned for all cases, and stapedectomy was performed at the second stage. After the second stage, 25 ears in the sixth month, 18 ears in the first year, 14 ears in the second year, and 7 ears in the tenth year were available for follow-up. Preoperative and postoperative air–bone gap values of the patients and their hearing gain were compared. Total stapedectomy was carried out in 17 of the patients and partial stapedectomy in 8 of them. For ossiculoplasty, a plastipore total ossicular replacement prosthesis was used in 17 patients, homograft ossicle in 2 patients, and Teflon piston in 6 patients. Results. In 17 cases in which we used total stapedectomy, the average preoperative air–bone gap value improved from 40.23 to 18.47 in the sixth month, and from 38.4 dB to 9.6 dB in the tenth year. In eight cases in which we used partial stapedectomy, the average preoperative air–bone gap improved from 38.63 dB to 24.38 dB and from 35 dB to 17 dB, respectively. The average postoperative hearing gain with total stapedectomy was 21.76 dB in the sixth month and 28.8 dB in the tenth year. Hearing gain with partial stapedectomy was successively 14.25 dB and 18 dB. When we compared the results of total prosthesis and Teflon pistons among the materials used in ossiculoplasty, although hearing gain with total prostheses was better, the results were not statistically significant.

Repair of nasal septal perforation with "cross-stealing" technique.

Background The aim of this study was to reveal the efficacy of the “cross-stealing” technique in the repair of nasal septal perforation. Methods In a prospective clinical investigation, 10 patients with the complaints of crusting, bleeding, whistling, nasal obstruction, and pain and in whom septal perforation was detected underwent surgery by endonasal approach between April 2006 and January 2008. During surgery, the inferior-based mucoperichondrial flap was prepared on one side, the superior-based mucoperichondrial flap was prepared on the other side of the nasal septum, and they were passed to the opposite side through perforation. Interpositional graft was placed between flaps and sutured. Patients were followed for a minimum of 5 months before the evaluation of the results. Results Complete closure was observed in 7 of 10 (70%) patients and partial closure was observed in 1 patient. In 2 patients perforation was not closed and its size remained unchanged. Conclusion The cross-stealing technique is advantageous in anterior-located septal perforations in that it can be performed endonasally and it is physiological. Because flaps are prepared in a vertical direction, it can be used only in small and middle-sized perforations, which restricts its use.

Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations

Objectives To evaluate endoscopic push-through technique cartilage myringoplasty results. Methods This prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies. Results Of 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences. Conclusion Underlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.

Bilateral simultaneous nasal septal cauterization in children with recurrent epistaxis.

OBJECTIVE To investigate the feasibility, effectiveness and complications of bilateral simultaneous silver nitrate cauterization for anterior nasal septal epistaxis in otherwise healthy children. METHODS Prospective study in a tertiary referral otorhinolaryngology department. Thirty-seven children with anterior epistaxis between the ages of 5-16 years were included in the study. The patients who had varicose vessels or network of small vessels in the Littles area had simultaneous bilateral silver nitrate cauterization. RESULTS Complete or near-complete epistaxis control was obtained in 76% of the patients after the first cauterization, and in 86% of the patients after the second cauterization in a mean follow-up period of 8 months. Partial success was obtained in five patients. The crusting in the cauterization area was healed late in six patients. Septal perforation, tattooing, or mucocutaneous/allergic reactions were not observed in any of the patients. CONCLUSIONS Bilateral silver nitrate cauterization is an effective, feasible, low-cost and preferable treatment method in childhood epistaxis when it is applied in an appropriate concentration and at an appropriate duration in a healthy mucosal environment.

Reply to the letter to the editor “In response to: The effects of different environmental pH on healing of tympanic membrane: an experimental study” 10.1007/s00405-016-3931-7

We would like to thank for valuable comments on our article titled ‘‘The effects of different environmental pH on healing of tympanic membrane: an experimental study.’’ In general, wound healing consists of hemostasis, inflammation, proliferation (fibroblastic), remodeling, and contraction phases. Hemostasis and inflammation phases in healing of TM are similar to other body tissues; however, there are differences in proliferation and migration phases. In other tissues, granulation tissue provides a bed for reepithelization, but squamous epithelium forms a bridge on the perforation in healing of TM perforation, and inner mucosal layer supports it. Then, fibrous layer is to be formed, but it is not formed in most of the cases. Thinning of TM takes place by remodeling of the fibrous layer [1–3]. Today this is the most widely accepted view in the repair of traumatic tympanic membrane perforation. In this study, we investigated the effects of acidic and alkaline pH on healing in early phase of wound healing (inflammation and proliferation phases) in acute TM perforations of the rats. The perforation closure rate was quite high in the acidic environment on day 7. In our opinion, this may be explained as follows: an acidic pH may help wound healing by suppressing infection and reducing catabolic and proteolytic activities, and/or provides an ongoing epithelization at the edges of the wound by inhibiting irregular fibroblast migration to the wound. Presence of inflammatory cells which are indicators of inflammatory phase, and observation of intense and irregular fibroblastic reaction in ears treated with the alkaline solution that had a bad healing on day 7 support our aforementioned opinion. In this study, it was observed that some inflammatory parameters, namely edema and neovascularization, were not affected by environmental pH. According to the data of this study, environmental pH affected fibroblastic reaction and inflammation phases, and an alkaline pH delayed wound healing while an acidic pH speeded up healing.