Kadir Serkan Orhan

Transcutaneous Bone-anchored Hearing Aids Versus Percutaneous Ones: Multicenter Comparative Clinical Study.

Objective The aim of this study is to compare the clinical audiological outcomes as well as patient satisfaction of bone-anchored, hearing aid surgery between the percutaneous Dermalock and the transcutaneous Attract systems. Study Design and Methods This is a multicenter, retrospective clinical study. The patients who underwent Baha Dermalock and Baha Attract surgery were analyzed for hearing results, surgical complications, and postoperative follow-up specifications for both systems. Speech reception thresholds and bone conduction thresholds with and without aided conditions were evaluated. Patient satisfactions were also determined for both groups by Glasgow Benefit Inventory questionnaire. Results Both of the groups had some minor complications such as skin irritations around the abutment and skin erythema over the magnet. Both of the groups benefit from the devices audiologically; however, when the groups were compared, better results were observed in the percutaneous, bone-conduction group. Conclusion We can confirm that both transcutaneous and percutaneous techniques are effective in the rehabilitation of conductive hearing loss when conventional hearing aids cannot be used. However, both of the systems have some advantages and limitations in terms of audiological and surgical perspectives.

Fascia lata graft for nasal dorsal contouring in rhinoplasty

Nasal dorsal irregularities are troublesome for both patient and surgeon, especially in patients with thin nasal dorsal skin. Many types of grafts have been used for nasal contouring; however, in this article, we report the use of fascia lata (FL) graft for dorsal contouring and camouflage in 63 patients who underwent rhinoplasty between May 2004 and December 2005. There were 26 male and 37 female patients, with ages ranging from 18 to 43 years (mean age: 28.7). Of the 63 patients, 49 underwent primary rhinoplasty, while 14 were secondary cases. An informed consent was obtained from all patients for the use of FL graft. The graft was harvested from the right lateral thigh. A simple method was used to place the graft over the nasal dorsum. Postoperative follow-up period was between 14 and 26 months (mean: 20). Clinical evaluation was made by inspection, palpation and photographic documentation. In addition, a questionnaire related to patient satisfaction and donor-site morbidity was sent to patients 1 year after surgery. All patients had satisfactory aesthetic results, and no apparent irregularities were observed over the nasal dorsum. The questionnaire results showed that all patients, but one, were satisfied with surgery, and were not concerned about donor-site scar; however, one patient had a donor-site morbidity. This study conclusively shows that TLF graft is a reliable, simple method for camouflaging any postoperative dorsal irregularities, particularly in patients with thin nasal skin.

Spinal accessory nerve function after neck dissections.

The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month. All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group. In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.

A new transcutaneous bone anchored hearing device - the Baha® Attract System: the first experience in Turkey.

OBJECTIVES In this study, we reported our experience with a new transcutaneous bone conduction hearing device, the Baha® Attract System. PATIENTS AND METHODS This multi-center clinical study included the first 12 patients (8 females, 4 males; mean age 27.6 years; range 5 to 65 years) in whom a new transcutaneous bone conduction system was implanted in Turkey. RESULTS The mean air-bone gap was 41 dB. Bone smoothing around the implant was needed in five patients. We placed a sound processor in the fourth postoperative week for all patients. CONCLUSION Our study results suggest that the new bone conduction implant is promising for the patients with conductive or mixed hearing loss who are unable to wear conventional air conduction hearing aid and comparable to percutaneous systems.

Subperiosteal temporal pocket versus standard technique in cochlear implantation: a comparative clinical study.

Objective: In the standard technique of cochlear implantation, the internal receiver-stimulator (IRS) is fixed into a socket drilled on the calvarial bone. In the subperiosteal technique, the IRS is fixed under the subperiosteal plane, and drilling is not necessary. The purpose of this study was to compare the subperiosteal and the standard techniques. Study Design: Retrospective clinical study. Setting: Tertiary referral center; cochlear implant program. Patients: One hundred forty-eight patients who underwent cochlear implantation. Intervention: The researcher who evaluated the patients was not informed which of the 2 techniques was used on the patients and administered a visual analog scale (VAS) analysis. The duration of the operation, intraoperative and postoperative complications, and migration of the IRS were assessed. Main Outcome Measures: A VAS survey was administered to the patients or to their parents to evaluate the practicability of the implant. Results: The duration of the operation was 73.4 ± 17.8 minutes in the subperiosteal group and 105.5 ± 17.8 minutes in the standard technique group. The difference was statistically significant. Intracranial complications or migration of the IRS was also not observed in any patient. The VAS score was 4.2 ± 2.1 in the standard group and 4.3 ± 1.9 in the subperiosteal group. The difference was not statistically significant. Conclusion: The subperiosteal technique can be safely and effectively used in cochlear implantation. Not only are there no intracranial complications and no migration of IRS was observed but also the mean operation time is reduced up to 30% and none of the patients have reported difficulty with fixing of the external device.

Evaluation of Factors Concerning the Olfaction Using the Sniffin’ Sticks Test:

Objective. This study aimed to research the normative values of olfactory function in the Turkish population using the Sniffin’ Sticks test and to relate olfactory performance to age, sex, smoking, educational level, and the side examined. It also aimed to compare the results with other countries’ normative values, especially Europe, using the same test and procedure. Study Design. Prospective clinical study. Setting. Tertiary referral center. Subjects and Methods. This study was a prospective clinical trial conducted in a tertiary clinic. A total of 100 healthy subjects were included in the study. Of these, 50 were men and 50 were women. The mean (SD) age of the subjects was 37.7 (14.8) years (range, 18-77 years). Results. Odor scores were lower than the scores of other countries, and the scores decreased significantly with age. There was no relationship between olfaction and sex or smoking. Subjects with a lower educational status had lower scores compared with the scores of median and highly educated subjects. Conclusion. This is the first study that evaluated the relationship between education level and olfaction. According to the results, the cultural differences, education level, and age seemed to influence odor scores. The Sniffin’ Sticks test can be used to assess olfactory performance in a Turkish population, but identification of odors in this test battery may show variability because of local and cultural factors.

The effect of spreader grafts on nasal dorsal width in patients with nasal valve insufficiency.

T he use of spreader grafts is a common procedure in rhinoplasty. Originally they served to widen the nasal valve, but they also proved to be very helpful in aesthetic corrections and repairing of the middle nasal vault. Especially in nasal surgery, changes in function often imply a change in outer appearance as well. It is supposed that a nasal valve angle narrower than 10° to 15° will cause inspirational obstruction. A positive Cottle sign is considered to be suggestive of nasal valve insufficiency. Because spreader grafts are placed between the caudal end of the nasal septum and the upper lateral cartilages, they are supposed to widen the nasal valve. To our knowledge, there are no studies that can clearly demonstrate this mechanical theory, but general agreement exists about their positive effect on nasal patency. Objective evaluation of the function of the nasal valve is difficult because any alteration in the contour of the vestibulum by a measuring device, and thus the caudal end of the upper lateral cartilages, will change the function of the valve. Therefore, rhinomanometry is hardly reliable. The use of a visual analog scale (VAS) provides a simple subjective method for evaluating nasal obstruction. In theory, spreader grafts used for improving the nasal valve function might be visible on the nasal dorsum. Although Faris et al showed that placement of spreader grafts does not result in a subjective change in aesthetic outcome, possible change of the dorsal width owing to placement of spreader grafts has never been objectified. The aim of this study was to investigate whether nasal spreader grafting influenced the outer appearance of the nose.

Olfactory Function Assessment of Blind Subjects Using the Sniffin’ Sticks Test

Objective In recent years, a growing number of studies have focused on the olfactory abilities of blind individuals as well as their tactile and auditory senses. In this study, we aimed to investigate possible alterations in the sense of smell in early- and late-blind subjects as compared with sighted controls, using a Sniffin’ Sticks test battery. Study Design Prospective clinical study. Setting Tertiary referral center. Subjects and Methods A total of 66 subjects were included in the study. The subjects were divided into 2 groups: blind subjects—who were then subgrouped as subjects with congenital blindness (n = 17) and those with acquired blindness (n = 16)—and sighted subjects (n = 33). We compared both congenitally and acquired blind subjects with sighted counterparts using the Sniffin’ Sticks test for odor threshold, odor discrimination, odor identification, and total odor scores. Results The blind subjects were more successful than their sighted counterparts in odor discrimination and odor threshold tasks. There was no statistically significant difference between the blind participants and the sighted individuals in terms of odor identification value. Another important finding was that the difference between individuals with congenital blindness and those with acquired blindness was not significant in any of the parameters. Conclusion This finding may suggest that odor discrimination and odor threshold in blind people were superior to those of controls. There was no difference in any of the results of tasks among congenital and acquired blind subjects.

Autologous fascia lata graft for contour restoration and camouflage in tertiary rhinoplasty.

Abstract Tertiary rhinoplasty is a surgical procedure to correct nasal deformities that have been developed after prior unsuccessful surgeries. Such surgery requires complicated manipulations and tissue grafting for proper restoration. In the current study, we report the use of fascia lata graft combined with cartilage grafts for contour restoring and camouflage. Twenty-three patients who had severe nasal deformities were included, of whom 14 were men and 9 were women. Their ages ranged between 24 and 34 years (mean, 29 y). All patients were twice previously operated on by surgeons other than the authors. An informed consent was obtained from all patients. After harvesting the costal cartilage, the fascia lata graft (mean size, 2–3 cm) was uniformly harvested from the right lateral thigh. Application of the fascia lata and the cartilage graft was achieved through the open rhinoplasty incision. The fascia lata was applied over the cartilage in the dorsal region in 20 patients (86.9%), applied over the reconstructed alar and dome area in the nasal tip in 8 patients (34.7%), and applied over both areas simultaneously in 4 patients (17.3%). Postoperative follow-up was between 14 and 35 months (mean, 24.5 mo); clinical evaluation, photographic documentation, and a questionnaire form related to donor-site morbidity and patient satisfaction were applied after 12 months of the follow-up period. Results showed that all patients had an improved aesthetic result, and no apparent irregularities were observed in the integument of the aesthetic lines. No complications or no requirement for revision surgery was observed later on. In conclusion, refinements of the nasal dorsum and the nasal tip in tertiary rhinoplasty are indeed important and difficult to be managed. Placing the fascia lata over the applied cartilage grafts provide a good cover that conceals the possible irregularities or distortions that may appear in the late postoperative period.

Follicular dendritic cell sarcoma of the nasopharynx

Follicular dendritic cell (FDC) sarcomas of the nasopharynx are rare tumours; only seven cases have been reported in the English language medical literature. The authors present an eighth case, which occurred in a 70-year-old woman whose main complaint was nasal obstruction. It has been more than 10 years since FDC sarcoma was reported to occur in extranodal sites, and clinical and pathological characteristics of extranodal FDC sarcomas remain to be defined. The lack of a high index of suspicion is the main reason for misdiagnosis. The authors point out the difficulties in the diagnosis and management of this rare condition.