Nuray Bayar Muluk

Endoscopic versus microscopic approach to type 1 tympanoplasty in children

OBJECTIVES We investigated the outcomes of the endoscopic versus microscopic approach to type 1 tympanoplasty in pediatric patients. METHODS In this retrospective study, the outcomes of 61 ears of 60 pediatric patients (33 male and 27 female) who underwent type 1 tympanoplasty were evaluated. One patient underwent a bilateral operation. The age range of the patients was 7-16 years. Group 1 underwent tympanoplasty with an endoscopic technique (n=32), and Group 2 underwent tympanoplasty with the conventional microscopic technique (n=29). A boomerang-shaped chondroperichondrial graft was used in both groups. The outcomes were analyzed in terms of the hearing gain, duration of surgery, and graft success rate. RESULTS In both groups, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values (in dB) in either group. The mean operative duration in Group 1 was significantly lower than that in Group 2 (51.37 vs. 67.03 min, respectively). In the preoperative evaluation, 65.6% of patients in Group 1 had larger perforations and 34.4% had smaller perforations. In Group 2, 58.6% and 41.3% of patients had larger and smaller perforations, respectively. Perforations were detected in two (6.25%), four (12.50%), and four (12.50%) of the patients in Group 1 at postoperative months 1, 6, and 12, respectively. Perforations were detected in two (5.71%) patients in Group 2 at postoperative months 1, 6, and 12. At 12 months postoperatively, there were smaller perforations in four (12.5%) of the children in Group 1 and in two (5.71%) of the children in Group 2. The difference between the perforation conditions (larger vs. smaller) was not significant in either group. The preoperative and postoperative increases in the ABG were associated. The operative duration was shorter in Group 1 than in Group 2. CONCLUSION In pediatric patients undergoing type 1 tympanoplasty, especially if the external ear canal is narrow and the anterior canal wall is prominent, the endoscopic and microscopic approaches appear to give equal results in terms of easy visualization of the entire tympanic membrane and no requirement for extra intervention to evaluate the ossicular system. A shorter operative duration is an advantage of the endoscopic tympanoplasty technique.

Subjective tinnitus and hearing problems in adolescents

OBJECTIVES We investigated the hearing problems and tinnitus frequencies in adolescents at three public primary and two high schools. METHODS This study was carried out at three public primary and two high schools. 428 Turkish school children (244 girls, 184 boys) were asked to voluntarily answer a set of questionnaires in their classrooms at the beginning of the training program. There were 250 students (105 male, 145 female) in Primary School and 178 (79 male, 99 female) students in High School. We used questionnaire to evaluate subjective tinnitus and hearing problems. Walkman usage, listening loud and noisy music, intra-familial physical trauma, concentration difficulty in class and school success were also evaluated. RESULTS In age-related groups (Group 1=11-13 years; Group 2=13-15 years; Group 3=16-18 years), hearing loss was present in 32.1% of Group 1, 19% of Group 2 and 28.3% of Group 3. Listening loud and noisy music was reported in 81.8% of Group 1, 95.4% of Group 2 and 87% of Group 3. Tinnitus was present 36.8% in Group 2, 33.5% in Group 1 and 31.5% in Group 3. Tinnitus after listening loud music was present in 42.7% of Group 2, 36.1% of Group 3 and 25.6% of Group 1. Among all students with tinnitus, 19.5% considered their school success as very good, 41.1% as good and 39.4% as bad. In students, using Walkman, tinnitus was seen both in the right and left ears. CONCLUSION Tinnitus may be seen in adolescents at primary and high schools. Listening loud and noisy music and Walkman usage may cause an increase in the frequency of tinnitus manifestation. Adolescents should be educated about the hazardous effects of loud music. Education should include families, teachers, students, and whole community. These issues should be taken into public health policy of the countries.

Transient evoked otoacoustic emissions and contralateral suppressions in children with auditory listening problems.

OBJECTIVES Transient evoked otoacoustic emissions (TEOAEs) are reflections of cochlear energy produced during the processing of sound. The suppression effect identified as the decrease with the additional tone stimulator of the otoacoustic emission amplitude is use for assessing efferent auditory system function. The aim of this study is to investigate the contralateral suppression effect (CSE) of transient evoked otoacoustic emissions (TEOAEs) in children with auditory listening problems (ALPs) compared to normal hearing children. METHOD The study group (Group 1) was consisted of 12 ALP children (8 males and 4 females), aged 5-10 years, and associated with receptive and expressive language delay. The control group was consisted of (Group 2) 12 children with normal hearing levels, matched according to gender and age of TEOAEs and CSE of TEOAEs were investigated at 1.0-4.0 kHz in both groups. RESULTS For right ear, at 1.0 and 3.0 kHz, TEOAE amplitudes of the ALP group were significantly lower than the control group. At 2.0, 4.0 and 5.0 kHz of the right ear and at 1.0-5.0 kHz of the left ear, TEOAE amplitudes were found as not different between ALP and control groups. Suppression values of the ALP group were significantly lower than the control group at 1.0-2.0 kHz of the right ear and at 2.0 kHz of the left ear. At the other frequencies, there was no significant difference between the suppression values of the ALP and control groups. CONCLUSION Lower suppression values in ALP group at all frequencies (significant at 1.0-2.0 and 2.0 kHz in the right and left ears, respectively) showed that cochlear and cranial maturation of the ALP group may lower than the control group. Since the age profile in both group is similar, we thought that ages effect on this results is not important. Our results showed that children with ALP have auditory processing difficulties in noisy environment. For understanding the efferent auditory system, patients with auditory processing disorders may be evaluated by the help of background noise.

The “physician on call patient engagement trial” (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients

In this prospective, multicenter, randomized, controlled, double‐blind study, we investigated the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis (AR) and asthma patients.

Antileukotrienes in Upper Airway Inflammatory Diseases

Leukotrienes (LTs) are a family of inflammatory mediators including LTA4, LTB4, LTC4, LTD4, and LTE4. By competitive binding to the cysteinyl LT1 (CysLT1) receptor, LT receptor antagonist drugs, such as montelukast, zafirlukast, and pranlukast, block the effects of CysLTs, improving the symptoms of some chronic respiratory diseases, particularly bronchial asthma and allergic rhinitis. We reviewed the efficacy of antileukotrienes in upper airway inflammatory diseases. An update on the use of antileukotrienes in upper airway diseases in children and adults is presented with a detailed literature survey. Data on LTs, antileukotrienes, and antileukotrienes in chronic rhinosinusitis and nasal polyps, asthma, and allergic rhinitis are presented. Antileukotriene drugs are classified into two groups: CysLT receptor antagonists (zafirlukast, pranlukast, and montelukast) and LT synthesis inhibitors (5-lipoxygenase inhibitors such as zileuton, ZD2138, Bay X 1005, and MK-0591). CysLTs have important proinflammatory and profibrotic effects that contribute to the extensive hyperplastic rhinosinusitis and nasal polyposis (NP) that characterise these disorders. Patients who receive zafirlukast or zileuton tend to show objective improvements in, or at least stabilisation of, NP. Montelukast treatment may lead to clinical subjective improvement in NP. Montelukast treatment after sinus surgery can lead to a significant reduction in eosinophilic cationic protein levels in serum, with a beneficial effect on nasal and pulmonary symptoms and less impact in NP. Combined inhaled corticosteroids and long-acting β-agonists treatments are most effective for preventing exacerbations among paediatric asthma patients. Treatments with medium- or high-dose inhaled corticosteroids, combined inhaled corticosteroids and LT receptor antagonists, and low-dose inhaled corticosteroids have been reported to be equally effective. Antileukotrienes have also been reported to be effective for allergic rhinitis.

Random Gap Detection Test and Random Gap Detection Test-Expanded results in children with auditory neuropathy

OBJECTIVES In auditory neuropathy (AN) children with hearing aids (HAs) or cochlear implant (CI), the speech perception improvement may not be in a significant degree. These children may perform speech perception after a few repeats. This condition may show that these children had difficulties in receiving and processing speech sounds. If the children with AN cannot distinguish the heard tones one or two in Random Gap Detection Test (RGDT), their benefit performances between hearing aids or CI may not be significant. It is thought that the answer of this question is closely related with unique auditory processing performance of each child. The aim of the study is to investigate the RGDT and RGDT-Expanded (RGDT-EXP) performance of five children with AN. METHODS In this study, RGDT was applied to five children with auditory neuropathy between ages of 7 and 13 years (study group) (3 male, 2 female). As a control group, RGDT was applied to 10 normal hearing children who had not auditory processing problem between ages of 7 and 16 years (5 male, 5 female). In the first test, all children were applied to RGDT and RGDT-EXP. Each child responded whether he/she heard one or two tones. Their responses were taken as verbally and/or hold up one finger or two fingers. In the second test, they were applied speech discrimination test in quiet environment and in noise. Gap detection thresholds (GDTs) were detected at 500-4000 Hz; and composite GDTs (CGDTs) were found for the study and control groups. GDT/CGDT>20 ms was considered as abnormal for temporal processing disorder. RESULTS Any of the children with AN who has no HAs; with HAs; and CI, could not be able to perform RGDT. Therefore the RGDT-EXP was applied in this group. In the study group, GDTs was all over 50 ms at 500-4000 Hz; and CGDTs were all over 50 ms for all children included into the study group with AN. In control group, except child 9 (GDTs were 25 ms at 3000 and 4000Hz); and child 10 (GDT was 25 ms at 500 Hz); GDTs were all in normal limits for 500-4000 Hz for all children included into the study as control group. CGDTs were all in normal limits for the control group, except child 9 (CGDTs were 22.50, slightly higher than normal limits). In the study group with AN, mean of the GDTs was all over the normal limits; and in control group, mean of GDTs were all in normal limits. The difference between the mean GDTs of the study group was significantly higher than the control groups at all frequencies of 500-4000. In AN group, CGDT (97.5+/-9.57 ms) was significantly higher than that of the control group (10.35+/-0.65 ms). CONCLUSION We concluded that these results may only not be explained by auditory processing performance or temporal aspects of audition of each child. Their gap detection was much worse for short duration stimuli than for longer duration stimuli. The present study showed that temporal processing, auditory timing and gap detection skills of the children with AN were found as delayed in advanced degree. These findings may indicate that the AN children cannot perform temporal asynchrony. Our results may help to understand why the children with AN cannot manage the speech perception; and why they understand the speech after a few repeats.

CT assessment of the effect of fluticasone propionate aqueous nasal spray treatment on lower turbinate hypertrophy due to vasomotor rhinitis

Conclusion. Fluticasone propionate (FP) aqueous nasal spray was objectively found to be effective and safe for the treatment of lower turbinate enlargement in patients with vasomotor rhinitis. Objective. To assess the efficacy of FP aqueous nasal spray treatment in lower turbinate hypertrophy due to vasomotor rhinitis using CT. Material and methods. Of 35 patients with hypertrophic lower turbinates due to vasomotor rhinitis, 20 were treated twice daily with FP aqueous nasal spray (200 µg/day) for 3 months continuously and 15 were treated with placebo vehicle as a control group. The local effect of the nasal spray was studied using CT and visual analog scales. Results. Treatment with FP provided significantly greater relief from the symptom of nasal obstruction compared with placebo over the entire 3-month treatment period (p < 0.001). When the change from baseline was compared between the two groups, FP produced statistically significant reductions in the mucosal area of the lower turbinates and in the thickness of the nasal mucosa after 3 months (p < 0.05).

Effects of listening ability on speaking, writing and reading skills of children who were suspected of auditory processing difficulty

OBJECTIVES The aim of this study was to investigate the effects of listening ability on speaking, writing and reading skills of children who was suspected of auditory processing difficulty (APD). METHOD This research was conducted with 67 children in 1st or 2nd grade of primary school. The first group (Group I-control) was comprised of 41 children without APD. The second group (Group II-study group) was comprised of 26 children with APD. Listening, speaking, reading and writing skills were evaluated by Observational Rating Scale (ORS) and analyzed in both groups. RESULTS Listening value of ORS in APD group was significantly lower; and, speaking, reading and writing values of ORS in APD group were significantly higher than control group (p=0.000). It was also found that, the main effect of listening skills was on speaking in normal childs, and on writing ability in children with APD. CONCLUSION It was concluded that, for school-aged children, APD can lead to or is associated with difficulties in written language.

Random gap detection test and random gap detection test-expanded: Results in children with previous language delay in early childhood

OBJECTIVES The children with difficulty in receiving sounds presented at rapid rates in speech sounds and language learning period, may have delay in speech sounds and language development due to hearing speech sounds not clearly. Auditory temporal processing (ATP) is the ability to perceive auditory signals of brief duration accurately when presented at rapid rates. ATP can be evaluated by the random gap detection test (RGDT), which detects a brief gap between two stimuli. In this study, we investigated performance of children with previous language delay (PLD), currently having disorders in more than one speech sounds, on random gap detection test (RGDT) and RGDT-expanded (RGDT-EXP) tests. METHODS 12 children (8 male, 4 female) with previous language delay (PLD) and complaint of expressing speech sounds distorted, were included into the study. They had applied language training for at least one-year period in the past and in the current time, their language development is normal. They expressed one or more speech sounds as distorted. The control group consisted of 10 normal hearing children with normal phonological development and language matched for age; and who had not PLD (5 male, 5 female). Children language levels were evaluated by Preschool Language Scale-4 test; or Clinical evaluation of language fundamentals, fourth edition (CELF-4) according to childs age. Speech sounds development was assessed by Speech Sound Development Test (SSDT). They were applied RGDT and/if necessary, RGDT-EXP. Each child responded whether he/she heard one or two tones. Their responses were taken as verbally and/or hold up one finger or two fingers. In the second test, they were applied speech discrimination test in quiet environment and in noise. Gap detection thresholds (GDTs) were detected at 500-4000 Hz; and Composite GDTs (CGDTs) were found for the study and control groups. GDT/CGDT > 20 ms was considered as abnormal for temporal processing disorder. RESULTS In the study group with PLD, mean of the GDTs were all over the normal limits; and in control group, mean of GDTs were all in normal limits. The difference between the mean GDTs of the study group were significantly higher than the control groups at all frequencies of 500-4000 Hz. In PLD group, CGDT (103.53 ± 11.63 ms) was significantly higher than that of the control group, (10.35 ± 0.65 ms) (p=0.021). CONCLUSION The children with PLD have difficulties in perception of speech sounds at a certain rate, even they have not language learning difficulties. Therefore, difficulty in distinguishing of speech sounds may cause especially receptive language development delay. We believe that perception of the speech sounds and language in a certain speed; and temporally degraded speech programmes should be incorporated into the training programme and may help to prevent delays.

Emotional effects of nasal packing measured by the Hospital Anxiety and Depression Scale in patients following nasal surgery.

The aim of this study was to test the validity of the Hospital Anxiety and Depression (HAD) Scale in patients who underwent nasal surgery as a method of screening for emotional disorders during their hospital stay. The study group consisted of 50 adult patients (29 male, 21 female) who underwent nasal surgery for different reasons, such as chronic sinusitis, nasal polyposis, and nasal septal deviation. Functional endoscopic sinus surgery and/or septoplasty were managed in these patients, and all of the patients had nasal packing applied bilaterally for 2 days. The HAD Scale was given to all of the patients 1 day before surgery and 1 day after surgery, with anterior nasal packing bilaterally during the hospital stay. The anxiety and depression levels of the male group were under the cutoff points. For the female group, the depression levels were under the cutoff points, and the anxiety levels were high in the preoperative period and decreased after the operation. Anxiety and depression levels in the pre- and postoperative periods for the male and female groups were analyzed by Paired t-test. No statistically significant result was found (p > .05). It was concluded that, for patients well informed about nasal packing and hospital conditions, nasal packing may be used safely, without any psychological disturbance. The HAD Scale should be a more useful screening method to diagnose emotional disorders, especially in patients who are hospitalized for a long time.