Necmi Arslan

Combined intratympanic and systemic use of steroids for idiopathic sudden sensorineural hearing loss.

Objective: To compare hearing results in idiopathic sudden hearing loss patients treated with systemic steroids alone or combined intratympanic and steroids. Study Design: Prospective. Setting: Tertiary referral hospital. Patients: Idiopathic sudden sensorineural hearing loss patients. Interventions: The patients in the systemic therapy group received consecutive administration of 100 mg intravenous methylprednisolone in the first day, 80 mg/day oral prednisolone in 3 divided doses for the next 2 days, and continued with oral administration of steroids by tapering the dose 20 mg in every 2 days. The patients in the combined treatment group received intratympanic injection of methylprednisolone (an approximate dose of 0.5 ml of 125 mg/ml). A total of 5 injections on alternate days were performed. Main Outcome Measures: The mean and median PTA gains of systemic corticosteroid therapy (SCT) group were 7.5 and 5 dB at 5th day, 12.1 and 7.5 dB at 10th day, and 13.0 and 8.8 dB at 15th day. The mean and median PTA gains for combined treatment (CT) group were 12.5 and 7.5, 17.8 and 13.8, 21.8 and 20.0 dB, respectively. Results: Both the mean and the median PTA gains were statistically significantly different between SCT and CT groups. According to improved hearing results (more than 10 dB gain), there was statistically significant difference between SCT and CT groups. None of the patients had an important complication. Conclusion: The results of this study suggest that adding intratympanic methylprednisolone to systemic therapy increases the probability of hearing recovery in ISSHL patients.

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.

Is septoplasty alone adequate for the treatment of chronic rhinosinusitis with septal deviation

Background The purpose of this study was to reveal the role of septoplasty in curing chronic rhinosinusitis (CRS) in patients with significant septal deviation. Methods This prospective study involved 26 patients with CRS and septal deviation. The patients were randomly divided into two groups according to the applied surgical procedures. In the first and second groups, septoplasty and septoplasty plus endoscopic sinus surgery were applied, respectively. Subjective (questionnaire) and objective (endoscopy and computerized tomography) success rates were used to analyze the results. Results Septoplasty alone and septoplasty plus endoscopic sinus surgery were applied in 57.7% (15/26) and 42.3% (11/ 26) of the patients, respectively. Success rates were 93.3% (14/15) and 81.8% (9/11), subjectively (p > 0.05), and 66.7% (10/15) and 54.5% (6/11), objectively (p > 0.05), respectively in each group. Conclusion We suggest that septoplasty alone can be adequate for the treatment of CRS with septal deviation.

Does Helicobacter Pylori Have a Role in the Etiology of Adenoid Hypertrophy

To investigate whether there is any association between nasopharyngeal reflux and adenoid hypertrophy in children by using 24-h pH monitoring with dual probe and to determine whether Helicobacter pylori simply colonises in adenoid tissue or it is present there temporarily due to extraesophageal reflux. A prospective study at a tertiary referral center. Thirty-two patients who underwent adenoidectomy, aged ranged between 4 and 13 were included. All children with adenoid hypertrophy underwent 24-h pH monitoring with a dual probe. Proximal probe was placed in the nasopharynx. The presence of nasopharyngeal reflux and gastroesophageal reflux were investigated by 24-h pH monitoring. The presence of H. pylori was investigated in adenoidectomy samples by HP-fast test. Of the 32 patients who underwent adenoidectomy, 5 had nasopharyngeal reflux positivity while 27 patients did not show nasopharyngeal reflux positivity with pH monitorisation. Helicobacter pylori could not be detected in 5 nasopharyngeal reflux positive children while 3 of 27 nasopharyngeal reflux negative children showed H. pylori positivity, one of them in the mucosa and others in the core. This study demonstrated the high incidence of nasopharyngeal reflux and gastroesophageal reflux in adenoid hypertrophy and the possible colonisation of H. pylori in the adenoid tissue. This may change the assesment of children with adenotonsillar hypertrophy in near future. However, more placebo controlled and double blind studies and larger series are still needed to support this hypothesis.

Long-term voice results of injection with hyaluronic acid-dextranomere in unilateral vocal fold paralysis.

Abstract Conclusion: Subjective and objective voice evaluation of patients injected with hyaluronic acid-dextranomere (HA-D) in the long term was not different from their preoperative values. HA-D injection does not provide an increase in the voice quality in the long term. Objective: This study was conducted to evaluate the long-term voice outcomes of injection with HA-D in patients with unilateral vocal fold paralysis (UVFP). Methods: Seventeen patients with UVFP underwent injection of HA-D. The patient group was composed of 13 women and 4 men with an age range of 34–56 years. The voice samples of patients were obtained before the injection and after the longest available follow-up. Long-term results were evaluated subjectively by the GRBAS scale and objectively by acoustic analysis. Results: The follow-up period was between 6 and 42 months. Fundamental frequency, jitter, and noise-to-harmonics ratio were decreased in the postoperative period. Shimmer was nearly the same. An increase in the S score and a decrease in R, B, and A scores were observed. Neither the GRBAS scale parameters nor the acoustic analysis results were statistically significantly different before injection and after long-term follow-up.