Sultan Biskin

Do the angle and length of the eustachian tube influence the development of chronic otitis media

To compare the eustachian tube (ET) angle (ETa) and length (ETl) of ears with and without chronic otitis media (COM), and to determine the relationship between ET anatomy and the development of COM.

Does the Degree of Septal Deviation Affect Cribriform Plate Dimensions and Middle Turbinate Length

Objective:To investigate the effect of septal deviation severity on the dimensions of the lateral lamina of the cribriform plate (LLCP), middle turbinate length (MTL), and the angle of the lateral lamella of the cribriform plate (ALLCP). Methods:Paranasal computed tomography (CT) scans of 148 patients with septum deviation (102 males, 46 females; age range 18–63 years) were retrospectively evaluated. The patients were divided into 3 groups according to the measured angle of nasal septal deviation as mild (<9°), moderate (9–15°), or severe (>15°). Height and width of LLCP, MTL, and ALLCP on both sides were measured and these parameters were compared between the groups according to the septal deviation side. Results:The nasal septum was deviated to the right in 73 patients (49.3%) and to the left in 75 patients (50.7%). The LLCP dimensions, MTL, and ALLCP between the groups at the contralateral side were not statistically different (P > 0.05). The LLCP height, ALLCP between the groups at the ipsilateral side were not statistically different (P > 0.05). There was a significant difference in the LLCP width at the ipsilateral side between the groups (P = 0.039). The MTL at the ipsilateral side was significantly different between the groups (P = 0.003). Conclusion:The severity of nasal septum deviation in patients with nasal septum deviation affects the ipsilateral LLCP width and the ipsilateral MTL. These findings suggest that the increase in the severity of septum deviation in patients undergoing endoscopic sinus surgery does not increase the risk of possible damages that may occur in LLCP.

Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy

Objective To assess pretreatment levels in the counts and percentages of leukocytes and the neutrophil-lymphocyte ratio (NLR) in benign and malignant salivary gland tumors (SGTs) while investigating whether NLR is an inflammatory marker for distinguishing low- from high-grade parotid gland tumors. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods This study was performed on 182 patients with SGTs (age range: 16-87 years; 93 male and 89 female) who were treated between January 2010 and May 2015. Pretreatment counts and percentages of leukocytes and NLR were measured preoperatively in benign and malignant tumors. Results Mean neutrophil percentage (63.50% ± 12.11% vs 58.76% ± 8.20%, P = .008) and NLR (3.29 ± 3.13 vs 2.13 ± 1.26, P = .008) were significantly higher in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte count (2.42 ± 0.72 103/mm3 vs 1.97 ± 0.87 103/mm3, P < .001) and percentage (30.67% ± 7.68% vs 26.86% ± 10.15%, P = .011) were lower in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte percentage and NLR were significantly different between low- and high-grade malignant parotid gland tumors (P = .026 and P = .030, respectively). Conclusion Elevated NLR could be an inflammatory marker to distinguish low- from high-grade malignant parotid gland tumors.

Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review

Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

The role of the nasal and paranasal sinus pathologies on the development of chronic otitis media and its subtypes: A computed tomography study

Objective: This objective of this study is to evaluate the presence and the coincidence of common nasal and paranasal sinus pathologies in adults suffering from chronic otitis media (COM) and its subtypes. Materials and Methods: The study group comprised 354 ears of 177 patients who underwent tympanoplasty with or without mastoidectomy from January 2013 to February 2015 due to uni/bilateral COM. Chronic suppurative otitis media, intratympanic tympanosclerosis (ITTS), cholesteatoma, and tympanic membrane with retraction pockets constituted subtypes of COM. The control group consisted of 100 ears of 50 adult patients with aural diseases other than middle ear problems. All patients were evaluated for the evidence of mucosal disease on paranasal sinuses, the presence of concha bullosa (CB), and the angle of nasal septal deviation (NSD) and thickness of the medial mucosa of the inferior turbinate were measured by coronal computed tomography images. Results: The incidence and the angle of NSD were found significantly higher in patients with COM (P = 0.028, P = 0.018; respectively). When ears with unilateral and bilateral COM compared in term of sinonasal pathologies, CB was found higher in patients with unilateral COM (P = 0.040). The presence of CB was significantly higher in ITTS when compared to other subtypes (P = 0.028). Conclusions: Our study suggests that obstructive nasal pathologies such as NSD and CB may play a role in the pathogenesis of especially unilateral COM. However, there was no correlation between COM and inflammatory pathologies such as sinusitis.

Histopathological Effects of Fibrin Glue and Cyanoacrylate on the Maxillary Sinus

Objective To compare the histopathological effects of fibrin glue (FbGl) and cyanoacrylate (CyAc) on the maxillary sinus mucosa. Methods Twenty rabbits were divided into two groups of 10, and surgical defects were created in the maxillary sinuses. The right maxillary sinus was treated with FbGl in one group and with CyAc in the other group. As a control, the left maxillary sinuses of all rabbits were treated with sterile saline solution. One rabbit treated with CyAc died during the study and was excluded. On postoperative day 21, all animals were sacrificed. Maxillary sinus mucosa samples were studied to determine the extent of inflammation and fibrosis, foreign body reaction, cilia loss, increased osteogenesis in bony structures under the mucosa, and loss of serous glands. Results The FbGl group differed significantly from the CyAc and control groups in terms of a high degree of inflammation (p<0.001), fibrosis (p<0.001), foreign body reaction (p<0.001), cilia loss (p<0.001), and serous gland loss (p<0.001). In terms of osteogenesis, there were no significant differences between the FbGl and CyAc groups (p=0.650), while there was a significant (p=0.002) difference between these two groups and the control group. Conclusion Histopathologically, CyAc had fewer side effects than FbGl. Further clinical studies are needed to demonstrate the validity of these results in humans.

Reply to the letter to the editor ''in response to: a better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials'' 10.1007/s00405-016-4019-0.

We have read Dr. Lou’s letter titled as ‘‘A better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials’’ with great pleasure [1]. Firstly we would like to make a short explanation about the technic used for the aspiration of the external ear canal in bacterial cellulose (BC) myringoplastia that we thought it was not fully understood [2]. We made a desepithelization to the perforation edges before the placement of the BC. This desepithelization process was applied in two ways: in some patients, medial and lateral layers of the tympanic membrane were separated, while in others, a millimetric piece of tissue was excised from the edges of the perforation. After that, a 1-mm expansion was detected in the perforation. Then, BC that is 2 mm wider than the perforation diameter was placed overlay. Millimetric pieces of spongostans were then placed over the BC. During the follow-up period, spongostans that are not melt away were aspirated. We should mention that we do not agree with the author’s opinion about the effects of desepithelization to the healing process of the tympanic membrane perforation. As all we know, the tympanic membrane consists of three layers. Outer layer is keratinized squamous epithelium, inner layer is non-keratinized mucosal epithelium, and middle layer is connective tissue. Epithelization occurs before fibrous tissue advancement in acute perforations (\3 months) [3], in which 81–96 % spontaneous closure rates have been reported [4, 5]. But, adversely, in chronic perforations, a contact inhibition occurs when outer layer epithelium and inner layer epithelium touch each other [6]. Our hypothesis is that contact inhibition causes an arrest in the epithelial proliferation, and connective tissue is coated with a solid epithelium. What we expect from an ideal graft material during wound healing in myringoplastia is to proliferate all three layers of the tympanic membrane. By desepithelization, firstly, the contact inhibition is eliminated, and additionally, release of growth factors, such as EGF and FGF, that cause an acute inflammation occurs. By this way, a contact of the connective tissue to the underlying fibrous tissue is provided. So, we think that the edge trimming (desepithelization) is an excellent method, and the development of new biocompatible materials reproduces the structure and mechanical properties. Currently, there are two approaches, such as surgical and tissue engineering, for myringoplastia. There is still no consensus on the optimal treatment for TM repair. Surgical technic has high success rates (with temporal muscle fascia, perichondrium and cartilage) however requires an additional incision for obtaining graft material and greater surgical time [7, 8]. Materials used for tissue engineering are biomolecules (growth factors as fibroblast growth factors, epidermal GF), cells and scaffold materials (decellularized tissue as a cellular collagen, alloderm and polymers as Gelfoam, silk fibroin, chitosan, sponges ex) [9, 10]. Another tissue engineering material that has been applied in vitro approaches is BC. Previously performed in vitro researches showed that BC has been shown to lead to proliferation in connective tissue of the This reply refers to the comment available at doi:10.1007/s00405-016-4019-0.

Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management.

Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature.

Midface Osseous Dimensions are not Affected by Uncorrected Nasal Septal Deviation

Methods: The study included 150 patients (104 males, 46 females; 18-63 years) who had paranasal sinus CT. The study population consisted of 51 patients with anterior nasal septal deviation (NSD) (group I), 72 patients with posterior NSD (group II) and 27 patients with no NSD (group III). By using multiplanar reconstruction (MPR) technique, on coronal plane the width of PA (PAW), the right and left maxilla spinal length (RMSL and LMSL) and the angle of the septal deviation (ASD) and on sagittal plane the height of the PA (PAH), the UAFH and the LM were measured.