Mustafa Çelik

Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties

INTRODUCTIONnVarious graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient.nnnOBJECTIVEnTo compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties.nnnMETHODSnIn total, 78 patients (38 males, 40 females; average age 10.02±1.98 years; range, 7-18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap≤20dB were regarded as a surgical success. Results with a p-value<0.05 were considered statistically significant.nnnRESULTSnThe graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68±11.44 dB and postoperative air-bone gap was 24.25±12.68dB. In the cartilage group, the preoperative air-bone gap was 35.68±12.94dB and postoperative air-bone gap was 26.11±12.87dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p<0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p>0.05). The average thickness of tragal cartilage in the pediatric population was 0.693±0.094mm in males and 0.687±0.058 mm in females.nnnCONCLUSIONSnOur data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate.

Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system

INTRODUCTIONnKnowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed.nnnOBJECTIVEnTo determine whether drug-induced sleep endoscopy (DISE) or Müllers maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS.nnnMETHODSnThe study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohens kappa statistic test).nnnRESULTSnThere was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%).nnnCONCLUSIONnWe suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.

Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo

INTRODUCTIONnBenign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder. The Dix-Hallpike and Roll maneuvers are used to diagnose BPPV.nnnOBJECTIVEnThis study aims to investigate the diagnostic value of repeated Dix-Hallpike and Roll maneuvers in BPPV.nnnMETHODSnWe performed Dix-Hallpike and roll maneuvers in patients who admitted with peripheral vertigo anamnesis and met our criteria. The present study consists of 207 patients ranging in age from 16 to 70 (52.67±10.67). We conducted the same maneuvers sequentially one more time in patients with negative results. We detected patients who had negative results in first maneuver and later developed symptom and nystagmus. We evaluated post-treatment success and patient satisfaction by performing Dizziness Handicap Inventory (DHI) at first admittance and two weeks after treatment in all patients with BPPV.nnnRESULTSnOf a total of 207 patients, we diagnosed 139 in first maneuver. We diagnosed 28 more patients in sequentially performed maneuvers. The remaining 40 patients were referred to imaging. There was a significant difference between pre- and post-treatment DHI scores in patients with BPPV (p<0.001).nnnCONCLUSIONnPerforming the diagnostic maneuvers only one more time in vertigo patients in the first clinical evaluation increases the diagnosis success in BPPV. Canalith repositioning maneuvers are effective and satisfactory treatment methods in BPPV.

Impact of Laryngopharyngeal Reflux on the Levels of Depression and Anxiety in Patients With Obstructive Sleep Apnea Syndrome

Objectives: The aim of the study was to assess the impact of the presence of laryngopharyngeal reflux (LPR) on the level of depression and anxiety in patients with obstructive sleep apnea syndrome (OSAS). Study Design: A nonrandomized, prospective clinical study. Methods: In total, 62 patients with an apnea-hypopnea index >5 were included in this study. Each patients completed the 21-item Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Epworth Sleepiness Scale (ESS), and Reflux Symptom Index (RSI). Patients were diagnosed with LPR based on laryngeal examination and symptom presentation, with RSI score >13. The patients were divided into 2 groups based on the presence of LPR. In group A, all patients were diagnosed with LPR. In group B, the patients had no diagnosis of reflux disease. Results: The mean RSI was 3.86u200a±u200a2.46 in group B and 17.2u200a±u200a6.34 in group A. The mean ESS scores did not differ between the groups (Pu200a=u200a0.107). Mean BAI and BDI scores were both higher in group A than in group B (Pu200a=u200a0.016 and Pu200a=u200a0.011, respectively). There was no correlation between RSI and BAI scores (ru200a=u200a−0.237; Pu200a=u200a0.063), BDI scores (ru200a=u200a0.191; Pu200a=u200a0.138), or ESS scores (ru200a=u200a0.210; Pu200a=u200a0.102). A positive correlation was found between RSI and apnea-hypopnea index scores (ru200a=u200a0.338; Pu200a=u200a0.007). Conclusion: The authors observed significantly higher levels of depression and anxiety in patients with LPR and OSAS. The authors suggest that the presence of LPR induces depression and anxiety in patients with OSAS and vice versa. Further studies involving larger numbers of patients are needed to confirm these initial findings.

Blood count values and ratios for predicting sleep apnea in obese children

OBJECTIVESnTo detect whether the mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are contributing factors in the diagnosis and severity of sleep apnea in obese children.nnnINTRODUCTIONnObesity is a public health problem, and its prevalence increases daily. Although PSG is the gold standard test in the investigation of sleep apnea, the application of this test requires equipment, personnel, time, and cost. There is no simple laboratory test for diagnosing and determining the severity of sleep apnea. Recently, MPV, NLR, and PLR, known as the inflammatory markers in CBC test parameters, have been investigated in some studies. We aim to investigate whether these parameters could provide a method for diagnosing and determining the severity of OSAS in obese children.nnnMETHODSnClinical records of 180 patients were evaluated. All subjects had venous blood samples collected from the antecubital vein in the morning, after an overnight fasting, one day before PSG. Hemoglobin, RDW, MPV, PLT, platelet distribution width (PDW), and WBC count were measured. After anthropometric and laboratory analysis, 127 obese children were assessed for sleep study. Eighty-three patients who met the required polysomnographic criteria were divided into three groups as follows: group A [non-OSAS, apnea-plus-hypopnea index (AHI)xa0<xa01], groupB (1xa0≤xa0AHIxa0<xa05), and groupC (AHIxa0≥xa05).nnnRESULTSnTotal recording time, total sleep time, sleep efficiency, REM, and NREM sleep stage latency values were not statistically significant among groups. However, the number of awakenings, AHI, oxygen desaturation events, mean oxygen saturation, lowest oxygen saturation, average desaturation, and snoring time values had significant difference among the groups. There was no statistically significant difference among the groups in terms of WBC, Hemoglobin, platelets, PDW, neutrophil, and lymphocyte values. However, RDW values showed a statistically significant difference between groups A and C. Although there was no statistically significant difference of MPV values among groups, NLR and PLR values were statistically significant between groups A and C.nnnCONCLUSIONnAccording to our study, NLR, PLR, and RDW were found to be significantly higher in children whose AHI was ≥5 than in children from the other groups. However, no correlation was found between MPV levels and OSAS in children.

Assessment of Effects of Septoplasty on Acoustic Parameters of Voice: A Prospective Clinical Study

ObjectivenTo investigate the effects of septoplasty on the acoustic parameters of voice.nnnMethodsnIn total, 23 patients (seven females and 16 males; average age, 32.13±9.67 years; age range: 19-56 years) with a diagnosis of nasal septal deviation and who underwent septoplasty were included. Preoperative and on postoperative 30th day, acoustic analysis of voice was conducted for all patients. The recordings of /mana/ vowel were used to evaluate average fundamental frequency (F0), jitter, shimmer, and noise-to-harmony ratio (NHR). F0, shimmer percent, jitter percent, and NHR of two terms were compared. A p-value<0.05 was considered to indicate statistical significance.nnnResultsnA statistically significant change was not observed in F0 (p=0.741), jitter (p=0.930), and shimmer (p=0.128) measured preoperatively and on postoperative day 30. However, the increase in NHR measured on postoperative day 30 were statistically significant compared with preoperative NHR (p=0.017).nnnConclusionnAccording to the findings of this study, except NHR value, no statistically significant changes on F0, jitter and shimmer were detected after septoplasty.

Vidian Canal Types and Dehiscence of the Bony Roof of the Canal: An Anatomical Study

ObjectivenTo determine the prevalence of Vidian canal types and dehiscence of the bony roof of the canal.nnnMethodsnThis study included 594 patients (391 males and 203 females; average age, 32.43±11.98 years; range, 18-65 years). Computed tomography (CT) images were analyzed in terms of the prevalence of Vidian canal types and dehiscence of the bony roof of the canal.nnnResultsnVidian canal types 1, 2, and 3 based on the sphenoid sinus body were found on the right side in 33.8%, 29.7%, and 6.5%, and on the left side in 36.4%, 27.4%, and 36.2% of the patients, respectively. Dehiscence of the bony roof of the canal was found on the right side in 22.2% of the patients and on the left side in 26.6%. In terms of Vidian canal types based on the sphenoid sinus floor, types 1, 2, 3, and 4 were found on the right side in 53.5%, 27.4%, 7.6%, and 11.5%, and on the left side in 54.9%, 26.6%, 6.6%, and 11.9% of the patients, respectively. On the right side, Vidian canal type 2 was significantly (p=0.002) more frequent in males than in females.nnnConclusionnWhen studying the complex anatomy of the sphenoid sinus, it is essential to consider Vidian canal types. Before endoscopic sinus surgery the Vidian canal and other anatomical structures should be carefully evaluated in all patients during preoperative paranasal sinus CT imaging to avoid complications.

Is ventilation tube insertion necessary in children with otitis media with effusion

OBJECTIVESnTo compare audiological outcomes of ventilation tube insertion(VTI) and myringotomy alone in association with adenoidectomy in patient with otitis media with effusion(OME).nnnSTUDY DESIGNnRetrospective clinical chart review.nnnSUBJECTS AND METHODSnIn total, 148 patients (78 male, 70 female; average age of 6,02 ± 1,98 years, range 4 to 7 years) who had been underwent adenoidectomy in association with VTI or myringotomy alone in our clinic were included in this study. Demographics and audiological outcomes were collected. The patients were divided randomly into two groups, group A (72) were subjected to adenoidectomy with VTI and group B (76) were subjected to adenoidectomy with myringotomy. Audiological outcomes comparing the both groups at six months also continued to patients follow up to one year after surgery. Results with a p-value <0.05 were considered statistically significant.nnnRESULTSnThe mean pure tone hearing threshold preoperatively in group A was 28.68 ± 11.72 dB, while it was 24.25 ± 12.68 dB in group B. At postoperative six months, the means in group A were 8.4 ± 2,32 dB, while the means were 10,4 ± 3,36 dB in group B. Statistical analysis showed statistically significant difference between the means of pure tone hearing thresholds in both groups during the whole follow up period (p<0.05).nnnCONCLUSIONnOur data suggest audiological outcomes of VTI was higher compared with myringotomy alone in association with adenoidectomy. However, further studies with a higher number of patients are needed to compare the audiological outcomes of various ventilation tubes types.

Glanzmann's thrombasthenia: a rare case of spontaneous bilateral hemotympanum

O hemotimpano pode ocorrer em decorrencia de varias con -dicoes, incluindo fratura do osso temporal, tamponamento nasal, epistaxe, terapia anticoagulante e doencas hemato-logicas. A trombastenia de Glanzmann, uma doenca hemor-ragica congenita rara, representa uma causa pouco frequente de hemotimpano. Apresentamos aqui um caso de hemotimpano bilateral espontâneo em trombastenia de Glanzmann.

Our Outcomes of Augmentation Mentoplasty with Solid Silicone

Objective: To evaluate our outcomes of augmentation mentoplasty with solid silicone in patients with retrognathia. Methods: In total, 17 patients (14 females, 3 males; average age 30.2 years; range 24-37 years) who underwent augmentation mentoplasty with solid silicone combined by septorhinoplasty were included in this study. Submental or gingivobuccal incision was performed in all the patients. The post-operative results of the augmentation mentoplasty were evaluated with reference to 3 criteria, i.e., patient satisfaction, physician aesthetic evaluation, and complications. The evaluation of the surgical results was formulated by adding scores from all 3 criteria. Results: The mean follow-up was 18.5 months with the shortest and the longest being 4 and 33 months, respectively. Gingivolabial incision was performed in 4 patients (23.5%) and submental incision was performed in 13 patients (76.5%), respectively. There were no permanent complications in any patient. Overall, 15 patients (88.2%) were extremely pleased with the procedure. In total, 16 patients (94.12%) showed a significant improvement after augmentation mentoplasty with solid silicone according to the aesthetic evaluation by the physician. Revision mentoplasty was not performed in any patient. Conclusion: Augmentation mentoplasty with solid silicone is a safe and effective means of creating a beautiful and balanced facial profile by producing alterations in the chin morphology with excellent and stable long-term results. Increased experience in augmentation mentoplasty will contribute to the further development of this surgery.