Semsettin Okuyucu

Effect of phosphodiesterase-5 inhibitor on hearing.

OBJECTIVE Following a report of sudden hearing loss in a patient taking phosphodiesterase type 5 inhibitor, and a Food and Drug Administration announcement concerning this class of drugs, a study was planned to investigate if ototoxicity occurs in patients using phosphodiesterase 5 inhibitor for erectile dysfunction. METHODS Eighteen patients with erectile dysfunction who had been using phosphodiesterase 5 inhibitor were included in the study. Audiometric tests were performed on all patients, between the frequencies 250 and 16,000 Hz, before and 1, 5 and 72 hours after drug ingestion. RESULTS Four patients showed a unilateral threshold decrease compatible with ototoxicity criteria; this change was reversible. A statistically significant difference in pre- versus post-drug hearing thresholds was observed in the right ear at 10,000 Hz (p = 0.008). There were no statistically significant hearing threshold differences at any other frequencies (p > 0.05). CONCLUSION Although temporary ototoxicity was noted in four patients, we could not find any permanent, deleterious effect of phosphodiesterase type 5 inhibitor on hearing thresholds.

Endoscopic dacryocystorhinostomy with silicone, polypropylene, and T-tube stents; randomized controlled trial of efficacy and safety.

Objective To compare the efficacy and safety of endoscopic dacryocystorhinostomy (En-DCR) with different stent materials for lacrimal sac intubation in primary nasolacrimal ductal obstructions. Study Design Randomized controlled study with three parallel groups. Level of evidence is 1b. Methods A total of 91 patients (five bilateral) with primary nasolacrimal duct obstruction (NLDO) at a tertiary referral center scheduled for En-DCR were to allocated into three stent groups with a sealed envelope and were randomized into three treatments: silicone, Prolene (polypropylene), and otologic T-tube. Ophthalmology and otolaryngology clinics evaluated the patients preoperatively and postoperatively with endoscopes, lacrimal system syringing, and dacryocystography. The success of the stents was evaluated 12 months after surgery with symptom relief and ostial patency. Complications were also noted. Results The overall success rate of the En-DCR in the stent groups was 78.1% (75/96); specifically, 87.5% (28/32) with silicone, 84.4% (27/32) with Prolene, and 62.5% (20/32) with T-tube. The efficacy of the procedures with the T-tube was significantly lower than that of the Prolene and silicone (p = .031, χ2 test). There were no significant differences between the silicone and Prolene (p = .718, χ2 test). Prolene was found to be related with orbital complications. Spontaneous loss is a particular complication of otologic T-tube and highly portends to failure. Conclusions The results of our study suggest that efficacy, defined as anatomic and functional success, is equally high for silicone and Prolene stents and lower for otologic T-tube in En-DCR.

The Score For Allergic Rhinitis study in Turkey.

Background The clinical definition of allergic rhinitis (AR) is difficult to use in epidemiological settings of large populations where it is impossible to obtain the laboratory evidence of each immune response. However, the standardization of the definition of AR in epidemiological studies is of crucial importance. This study was designed to estimate the prevalence of AR in an adult general population with respect to seven distinct geographical regions in Turkey. Methods Individuals were evaluated with the Score for Allergic Rhinitis (SFAR) questionnaire for a national cross-sectional study. The Turkish version of the SFAR questionnaire was tested for clarity and sensitivity in a small sample of the general population. Results Among the 3967 interviewed subjects, the overall prevalence of AR was 29.6%, with regional variations (from 21.0% in the southeastern Anatolia region to 36.1% in the Marmara region). The prevalence was higher in women and in urban area of residence. Conclusion This national survey confirmed the elevated prevalence of AR in Turkey. Our findings may contribute to the formulation of the public health policy and development of preventive and therapeutic strategies for AR in eastern Europe.

Prolene: a novel, cheap, and effective material in dacryocystorhinostomy.

Conclusion. Prolene® is cheap, effective, and readily available in almost all operating theaters. It might be used successfully in endoscopic dacryocystorhinostomy and is promising as an alternative to silicone stent intubations, especially in settings with limited resources. Objective. To evaluate the clinical efficacy and results of stenting with polypropylene (Prolene®; Ethicon, Inc.) suture material instead of silicone tube in endoscopic dacryocystorhinostomy. Patients and methods. Forty-two endoscopic dacryocystorhinostomy operations were performed in 36 patients (11 men and 25 women; mean age 34.7±9.5 years, range 16–60 years) between 2007 and 2008. After creating an aperture in the medial wall of the lacrimal sac, 2/0 Prolene was inserted through the canaliculi into the sac. The Prolene was left in the lacrimal sac for 3 months. The patients were followed up for between 6 and 18 months (mean 8.1±3.6 months). The improvement in the complaint of epiphora was grouped as very good, good, or no change. Results. The improvement in 34 eyes (81%) was reported as very good, whereas improvement was noted as good in 5 eyes (11.9%), and there was no change in 3 eyes (7.1%). We observed granulation tissue formation around the Prolene in two patients.

The prevalence and significance of incidental middle ear and mastoid cavity abnormalities on MRI in a pediatric population

OBJECTIVE The purposes of this study were to determine the prevalence of abnormalities in the middle ear and mastoid cavity on the magnetic resonance imaging (MRI) in children and correlate the results with clinical data, tympanometric findings and paranasal sinus changes. MATERIALS AND METHODS A total of 85 consecutive pediatric patients for suspected non-inflammatory intracranial pathologies were prospectively examined. MRI was conducted for the suspected intracranial pathology. All patients were also examined by an otolaryngologist for otologic pathologies. A tympanometry examination was performed in patients prior to MRI scan. RESULTS In 23 (27.1%) of 85 (39 males, 46 females) children, MRI demonstrated middle ear and/or mastoid cavity abnormalities. MRI abnormalities of the middle ear and/or mastoid cavity were correlated with clinical data and tympanometric findings. CONCLUSIONS Incidental abnormal signal intensities in the middle ear and/or mastoid cavity are frequent in children, especially in first years of life. MRI will demonstrate incidental middle ear and mastoid cavity abnormalities seems to have clinical significance.

The effect of anesthetic agents on perioperative bleeding during tonsillectomy: Propofol-based versus desflurane-based anesthesia

OBJECTIVE: Hemorrhage during tonsillectomy is related to the surgical technique, management of bleeding, and choice of anesthetic agent. This study evaluated the effects of anesthetic agents on hemorrhage during tonsillectomy with standardized surgical techniques and management of bleeding. STUDY DESIGN: Double-blind, randomized controlled trial. SUBJECTS AND METHODS: Sixty patients, aged 3 to 12 years, who were scheduled for elective tonsillectomy were enrolled in the study. Propofol-based anesthesia was administered to the first group; desflurane-based anesthesia, to the second. The amount of blood loss due to hemorrhage was measured. RESULTS: Propofol-based anesthesia significantly decreased bleeding during tonsillectomy. CONCLUSION: Propofol-based anesthesia is a reliable method for use in children who undergo tonsillectomy.

Acute 'upside-down' visual inversion due to multiple sclerosis

In a 20-year-old male patient, a 180 degree inversion of visual image was found as a manifestation of multiple sclerosis. Upside down reversal of vision is not a well-known sign in multiple sclerosis. Exact mechanism is still unknown. Lesions involving cortical areas, mainly the parieto-occipital region, have occasionally been documented. To our knowledge this is the first report of upside-down reversal of vision in multiple sclerosis with cerebra lesion on MRI. Multiple Sclerosis 2008; 14: 266—267. http://msj.sagepub.com

The effect of dacryocystorhinostomy on mucociliary function

Objective: External dacryocystorhinostomy is suspected to cause mucociliary dysfunction by affecting ciliary activity and quality of the mucus. We hypothesized that patients who undergo endoscopic dacryocystorhinostomy may also experience mucociliary dysfunction. We evaluated the effects of surgery on mucociliary clearance time in patients who underwent endoscopic dacryocstorhinostomy and external dacryocstorhinostomy. Study Design: A prospective controlled study. Subjects and Methods: Forty-four patients were studied: 22 had undergone one-sided endoscopic surgery and 22 had undergone one-sided external surgery for nasolacrimal duct obstruction. Nonoperated sides of the both groups were remained as controls. The saccharin test was used to evaluate the mucociliary clearance time of the both sides. Results: Dacryocystorhinostomy, results in prolonged mucociliary clearance times either endoscopic or external approach is performed (P < 0.001, paired t test). There was no significant difference between the mucociliary clearance times after endoscopic and external dacryocystorhinostomy (P = 0.22, Students t test). Conclusion: Dacryocystorhinostomy impairs mucociliary function independent of the type of surgery.