Şinasi Yalçin

Role of free oxygen radicals in noise-related hearing impairment.

This study was aimed at defining the relationship between noise-related hearing impairment in industrial workers exposed to continuous noise. For this malondialdehyde and glutathione peroxidase were analyzed as free radical form and antioxidant form. A total of 60 patients working in the units of a hydroelectric power plant were included in the study. This experimental group was further divided into three subgroups of 20 workers, each group exposed to a different noise level. The control group consisted of 20 male volunteers employed in the Medical Centre where the study was carried out. A standard ascending/descending method was applied to the subjects of the experimental and the control groups in order to determine their hearing thresholds at seven different frequencies between 250 and 8000 Hz. Then, 10 ml blood was collected from each person to measure the malondialdehyde values in plasma and glutathione peroxidase activity in erythrocytes. Slight sensorineural hearing impairment was found in group I beginning at 4 kHz and in group II beginning at 6 kHz. Statistically significant differences were observed in group I and II when compared to the control group (P<0.05). It was found that malondialdehyde levels increased in the experimental groups more than in the control groups. However, this increase was only significant in group I (P<0.05). Erythrocyte glutathione peroxidase activity significantly increased in group I and II compared to the other groups (P<0.05), also, the difference was significant between group I and II (P<0.05). Accordingly, it is suggested that free oxygen radicals may take a role in noise-related hearing impairment.

Hearing parameters in noise exposed industrial workers

This paper presents the results of a study carried out in a group of noise-exposed workers in a hydro-electric power plant. Thus, the main focus of the study is on 130 industrial workers who were exposed to high level of noise. The control group was consisted of 33 subjects with normal hearing. Hearing and acoustic reflex thresholds were obtained from all subjects and the results from age-matched subgroups were compared. The sensorineural hearing loss which were detected in 71 workers were bilateral, symmetrical and affected mainly frequencies of 4-6 kHz. In essence, the hearing losses were developed within the first 10 years of noise exposure and associated with slight progress in the following years. When acoustic reflex thresholds derived from the study and control groups were compared, statistically significant difference was determined only for the thresholds obtained at 4 kHz (p < 0.0005).

Bacteremia during tonsillectomy

OBJECTIVE To investigate bacteremia in patients who underwent tonsillectomy with a dissection method due to chronic tonsillitis, which may lead to dramatic results in patients that have a cardiovascular infection risk. In this study, it was explored whether the tonsil surface and the tonsil tissue interior microorganisms are different or not, and whether these microorganisms carry bacteremia development risk. METHODS Forty patients were enrolled in the study in ENT Clinic, Firat University. A bacteriological research was performed on patients with no treatment with antibiotics for a month before the operation. Tonsil surface and deep tissue cultures were performed, and venous blood samples were taken for cultures before and after the operation. RESULTS Surface and deep tissue cultures of tonsils of the cases represented a different result in 27.5% of the patients. No reproduction was observed regarding the blood cultures taken before tonsillectomy. Bacteremia was found in blood samples of ten patients (25%) taken immediately after tonsillectomy. CONCLUSION Hence, it has been concluded that different microorganisms may be present among the tonsil surface and tonsil deep tissue cultures and that bacteremia may develop after tonsillectomy. Therefore, to prevent the possible dramatic outcomes after tonsillectomy the required measures during the preoperative period should be taken into consideration, especially in patients that have chronic tonsillitis with cardiovascular disease.

Resistant bacteria in the adenoid tissues of children with otitis media with effusion

OBJECTIVE To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME). METHODS This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001. Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy. Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated. The resistance of penicillin was confirmed by MIC test. The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy. RESULTS In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01). In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group (P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them. The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures. CONCLUSION The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME.

The role of free oxygen radicals in noise induced hearing loss: effects of melatonin and methylprednisolone.

The aim of this study was to investigate the role of cochlear damage caused by free oxygen radicals occurring as a result of exposure to noise and to determine the prophylactic effects of melatonin and methylprednisolone. Fifty male albino guinea pigs were randomly divided into five groups. All groups were exposed to 60 h of continuous wide band noise at 100+/-2 dB, except group I. Group I was not exposed to noise or treated with drugs. Group II was exposed to noise and not treated with drugs. Group III was exposed to noise and treated with melatonin. Group IV was exposed to noise and treated with methylprednisolone. Group V was exposed to noise and treated with melatonin and methylprednisolone. A high dose of 40 mg/kg methylprednisolone and/or 20 mg/kg melatonin were administered intramuscularly 24 h before exposure to noise, immediately before noise exposure and once a day until noise exposure was completed. Just after the noise ended, guinea pigs were decapitated. Venous blood was obtained into tubes with EDTA and it was used to measure activity levels of plasma malondialdehyde, erythrocyte glutathione peroxidase and the cochlear tissue malondialdehyde. After the noise ended, in comparison group II with I; it was found that the malondialdehyde activity of the plasma and tissue had increased, the erythrocyte glutathione peroxidase activity levels had decreased and consequently, hearing thresholds had increased (P<0.01). A significant difference was found in the malondialdehyde and erythrocyte glutathione peroxidase activity levels between groups II and III (P<0.01) and the hearing thresholds exhibited a parallel trend (P<0.05). The hearing threshold and malondialdehyde activity levels obtained from groups IV and V were found to be similar to those of group II (P>0.05). As a conclusion, we suggest that the use of methlyprednisolone in order to prevent the cochlear damage caused by noise does not provide sufficient prophylaxy, however the use of melatonin provides a more effective prophylaxy, thus being a promising alternative.

First branchial cleft sinus presenting with cholesteatoma and external auditory canal atresia

First branchial cleft abnormalities are rare. They may involve the external auditory canal and middle ear. We describe a 6-year-old girl with congenital external auditory canal atresia, microtia, and cholesteatoma of mastoid and middle ear in addition to the first branchial cleft abnormalities. Clinical features of the patient are briefly described and the embryological relationship between first branchial cleft anomaly and external auditory canal atresia is discussed. The surgical management of these lesions may be performed, both the complete excision of the sinus and reconstructive otologic surgery.

Bacteriemia during mastoidectomy and/or tympanoplasty.

OBJECTIVE: To investigate the risk of bacteriemia development during surgery in patients who underwent mastoidectomy and/or tympanoplasty for chronic otitis media. PATIENTS AND METHODS: A total of 59 patients with chronic otitis media who were undergoing tympanoplasty operation with or without mastoidectomy were enrolled in this study. Smear cultures were obtained from outer ear canal and/or middle ears of all patients before the operation. Venous blood samples were obtained before and after the operation for bacteriologic analysis. Smear cultures were also obtained from the pressure dressing material that was applied during the operation for retrieval of the outer ear canal pressure. RESULTS: There was a 13.5% difference between the outer ear canal and/or middle ear smear cultures and ear pressure dressing smear cultures of the same case. There was no growth in the blood cultures obtained before tympanoplasty in any of the involved cases, however, in 5 (8.4%) of the culture samples obtained immediately after the tympanoplasty operation, there was bacteriemia. In the pressure dressing smear cultures obtained after the operation, 11 patients had microbial growth. CONCLUSION: Risk of bacteriemia should be considered in the preoperative period for the patients undergoing mastoidectomy especially in patients with cardiovascular diseases, this is of importance for the dramatic consequences that might arise after the operation. We also think that bacteriemia is also one of the factors that influences graft success rate.

Effects of interferon-α2b on hearing

The aim of the present study was to investigate the effects of interferon-α2b treatment on hearing in patients with chronic active hepatitis B. Twenty-six patients with chronic active hepatitis B were enrolled in the study, and puretone audiometry was performed to determine hearing thresholds of the patients before and at the end of 6 months of interferon-α2b treatment. There was no significant change in hearing thresholds of patients after treatment with interferon-α2b (p > 0.05). The results of the present study indicate that interferon-α2b therapy does not have any negative effect on hearing thresholds of patients with chronic active hepatitis B. There is a need for further studies involving larger numbers of patients to allow conclusions to be drawn regarding the safety of this therapy with respect to hearing. Sumario Existen algunas publicaciones que reportan pérdida auditiva sensorineural en pacientes tratados con interferón. El objetivo del presente estudio fue investigar los efectos del tratamiento con interferón-α2b en la audición de pacientes con hepatitis B crónica activa. Se incluyeron en el estudio veintiséis pacientes con esa enfermedad y se realizó audiometría tonal para determinar sus umbrales auditivos antes y al final de tratamiento con interferónα2b. No hubo cambios significativos en los umbrales auditivos después del tratamiento con interferón-α2b (p > 0.05). Los resultados del presente estudio indican que la terapia con interferón-α2b no tiene efectos negativos en los umbrales auditivos de pacientes con hepatitis B crónica activa. Existe la necesidad de más estudios en los que se involucre a un mayor número de pacientes, que permitan obtener conclusiones relacionadas con la seguridad de esta terapia en relación con la audición.

Septum perforation due to the use of Ecbalium elaterium

Ecbalium elaterium is a weedy ciliated oval shaped plant from Cucurbitacea family. The surface of the plant is covered with thorn-like hard cilia. The plant has fruits of 3–5 cm in diameter; the fruits are green in colour and get yellowish during the process of ripening. The fruits, roots, leaves and the stem of the plant have been the topic of many research studies (1). The roots and pickle-like fruits of E. elaterium have been used for medicinal purposes by the local people since ancient times. The juice of the fruit is reported to have potent cathartic, analgesic and anti-inflammatory effects (1,2). Local people widely use it for the treatment of sinusitis after diluting (2). It is also used for constipation, jaundice and as an anti-inflammatory agent (3). Dilution is thought to reduce its efficacy by 10-fold. When used without dilution, the juice of the fruit is very toxic causing oedema of the upper respiratory tract, dyspnea and headache. Moreover, the utilisation of the fruit juice without dilution is reported to cause life-threatening conditions (2,4). The utilisation of E. elaterium extract has been reported to cause acute glaucoma crisis, laryngeal oedema, sensorineural hearing loss and fatal cardiac and renal failure (2–5). The juice of the fruit exerts its cathartic, purgative and antitumoral effects by a substance called belaterin that precipitates upon waiting (6). The extract called Ecbalium is extracted from the roots and the leaves and used for dermal health; the product obtained with ethanol extraction from the roots has been used in the treatment of alopesia (3). Nasal septum perforations are well-known yet rare complications of septal surgery. Other than septum surgery, traumas, infections, neoplasia, collagen-vascular diseases and inhaled agents might result in septal perforation (7). In this article, we present a case who developed nasal perforation due to toxic effects of E. elaterium extract after using it as a nasal drop for the treatment of sinusitis without diluting, and we discuss this case together with the findings in the literature.

Hearing in workers exposed to low-dose radiation for a long period

The aim of the present study was to evaluate changes in hearing thresholds with standard and high frequency audiometry in workers exposed to low-dose ionizing radiation for a long period. A total of 57 (49 male and 8 female) technical staff working in radiology-related jobs who were exposed to occupational radiation were included in the study. The control group consisted of 32 (27 male and 5 female) volunteer subjects with normal hearing. The symptoms like tinnitus, vertigo, weakness and lack of appetite were evaluated. A standard ascending/descending method was applied to the subjects of the study and the control groups in order to determine their hearing thresholds at eleven different frequencies between 250 and 16,000 Hz. In the study group, the working duration of subjects ranged from 4 to 23 years, and the percentage of tinnitus, weakness, vertigo and lack of appetite were 47%, 28%, 24% and 17%, respectively. It was observed that pure tone hearing thresholds were markedly increased for 4,000, 6,000, 8,000, 14,000 and 16,000 Hz frequencies in the study group compared to the control group (p<0.01). Levels of static compliance and middle ear pressures of the study group were similar to the control group. Tinnitus, vertigo and hearing loss in high frequencies were observed in the subjects exposed to the radiation for a long period. Subjects under high risk should be evaluated periodically. We suggest that the use of standard and high frequency audiometry together could be beneficial in the evaluation of these subjects.