Tolgahan Catli

Facial reanimation with end-to-end hypoglossofacial anastomosis: 20 years' experience.

OBJECTIVE This study aimed to evaluate retrospectively the results of experience with end-to-end anastomosis of cranial nerves VII and XII, performed due to transection of the facial nerve during acoustic neuroma removal. METHODS We assessed the facial reanimation results of 33 patients whose facial nerves had been transected during acoustic neuroma excision via a retrosigmoid approach, between 1985 and 2006, and who underwent end-to-end hypoglossofacial anastomosis. We compared the facial nerve functions of patients receiving short term (two to three years) and long term (more than three years) follow up, and we assessed any complications of the anastomosis. RESULTS A House-Brackmann grade III facial function was achieved in 46.2 and 86.4 per cent of the patients in the short and long term, respectively. House-Brackmann grade IV facial function was achieved in 53.8 and 13.6 per cent of the patients in the short and long term, respectively. There was a statistically significant difference between the facial recovery results, comparing the short and long term follow-up periods (p = 0.03). Disarticulation was the most common complication, seen in 19 (57.6 per cent) patients; numbness of the tongue was the next commonest (10 (30.3 per cent) patients). None of the patients developed dysphagia. CONCLUSION Despite such morbidities as disarticulation and tongue numbness, end-to-end hypoglossofacial anastomosis is still an effective procedure for the surgical rehabilitation of static and dynamic facial nerve functions. Significant improvement in facial nerve function can occur more than three years post-operatively.

Thermal welding versus cold knife tonsillectomy: A prospective randomized study

This is a prospective randomized study conducted in a group of children who underwent two methods of tonsillectomy: thermal welding or cold knife tonsillectomy. Parameters, such as postoperative pain scores, intraoperative blood loss, operation time, and postoperative bleeding rates, were analyzed to find out which technique is better. Ninety‐one children (aged between 2 years and 13 years) with recurrent tonsillitis, obstructive sleep apnea syndrome, or both were included in the study. According to the type of tonsillectomy procedure, the patients were divided into two groups: cold knife and thermal welding procedure. The two groups were compared on the basis of postoperative pain scores, intraoperative blood loss, operation time, and postoperative bleeding. Fifty‐seven patients underwent thermal welding tonsillectomy and 34 had cold knife tonsillectomy. The mean pain score in thermal welding group was significantly lower (p < 0.001). There was no remarkable blood loss intraoperatively in the thermal welding procedure. The operation time was not significantly different between two groups. No postoperative bleeding was encountered in the thermal welding group. Compared with the cold knife technique, thermal welding was found to be a relatively new and safe technique for tonsillectomy as it results in significantly less postoperative pain and no remarkable blood loss.

Rhinorrhoea in the elderly

The ageing population has various medical problems, ranging from relatively minor to truly severe. The ageing process includes physiological changes that can also aggravate sinonasal problems such as rhinorrhoea. As one of the most troublesome condition of this population, the causes of rhinorrhea can be classified as “age related, medication induced, secondary to rhinitis and other causes (tumour, cerebrospinal fluid (CSF) leakage, etc.)”. The underlying aetiology should be meticulously investigated. Although common conditions such as “allergic or infectious rhinitis” are relatively easy to diagnose and threat, more serious causes such as “primary spontaneous CSF rhinorrhea” are hard to manage. The treatment options should be individualised to the patient according to his or her metabolic, cardiac and central nervous system status. Rapid and accurate diagnosis and treatment of the pathology would not only increase the quality of life but also decrease morbidity and mortality of this population. As a conclusion, rhinorrhoea in the elderly is an important condition that should not be overlooked.

Swelling around the implant body: A late complication of cochlear implantation. How to deal?

Abstract Objective In this retrospective review, we aimed to determine the most appropriate management of the complication of late swelling around the implant body following cochlear implantation. Methods The medical records of 516 patients who underwent cochlear implantation between January 2008 and June 2013 were reviewed for a history of swelling around the implant body. Results Of the 516 patients, 16 (8 males and 8 females) had a history of swelling around the implant body following implantation. The onset of swelling was from 1 to 60 months (median 21.2 months) after implantation. Three of the 16 patients had a history of manifest trauma to the head, and the remaining 13 had experienced an upper respiratory tract infection just before the swelling arose. Discussion In the light of our clinical experiences, we may suggest that late swelling around the implant body seems associated with a manifest or hidden head trauma or upper respiratory tract infections. Conclusion After the initial assessment of swelling, surgeons should be aware of the possibility of abscess formation. As a general rule, any kind of pus collection should be drained surgically. However, in the case of pus collection without abscess formation, conservative measurements can often achieve satisfactory results.

The new classification system for inner ear malformations: the INCAV system

Abstract Conclusions: The proposed INCAV system standardizes reporting of inner ear malformations; gives adequate information about the structures of inner ear; defines the ears which could not be classified before; and helps in the selection of the ear as the cochlear implant candidate. Also it is easy-to-use for radiologists, and useful to the referring otolaryngologists. Objective: This study was conducted to explore a more specific, definitive classification system which was based on radiological criteria for inner ear malformations. Method: This study found 43 patients who had inner ear malformations, magnetic resonance (MR), and computed tomography (CT) imaging, together with the retrospective evaluation of the medical records between August 2010 and February 2015. It analyzed inner ear structures by dividing five sub-groups and each sub-group was given a letter: internal acoustic canal (I), cochlear nerve (N), cochlea (C), vestibular aqueduct (A) and vestibule (V). Based on their malformations, these anatomical structures have been assigned grades and have been classified by using increasing numbers which were dependent to increasing order of severity of the malformation. Results: Among these 43 patients, there were six normal (I0N0C0A0V0) and 80 inner ear malformations. All of the ears were defined successfully by the INCAV system.

Waardenburg Syndrome: An Unusual Indication of Cochlear Implantation Experienced in 11 Patients

OBJECTIVE The aim of this study was to present the surgical findings of children with Waardenburg syndrome (WS) and investigate speech development after cochlear implantation in this unique group of patients. MATERIALS AND METHODS A retrospective chart review of the patients diagnosed with WS and implanted between 1998 and 2015 was performed. Categories of auditory performance (CAP) test were used to assess the auditory skills of these patients. CAP is a nonlinear hierarchical scale used to rate a childs developing auditory abilities. Preoperative test results and intraoperative surgical findings of these patients have been presented. RESULTS In total, 1835 cases were implanted a tour institution, and 1210 of these were children. Among these implantees, 11 were diagnosed with WS (0.59% of all implantees). Four of the 11 patients showed incomplete partition type 2bony labyrinth abnormality (Mondini deformity) and all patients showed intraoperative gusher during cochleostomy, which was subsided through routine interventions. No other complications occurred during surgery, and all patients showed satisfactory CAP results in the late postoperative period. CONCLUSION Our experiences with cochlear implantation in patients with WS showed that the procedure is safe and effective in this group of patients. Surgeons should be aware of possible labyrinth malformations and intraoperative problems such as gusher in these patients. In long term, auditory performances may exhibit satisfactory results with optimal postoperative educational and supportive measures.

Kırsal alanda kulak burun boğaz hekimliği

Objective: In this study, our aim was to evaluate statistically demographic distribution, presenting complaints, requested examinations, prescribed drugs, and follow-up recommendations related to the patients who applied to the otorhinolaryngology outpatient clinics in a rural area of Turkey. Methods: Examinations, and treatments applied by three physicians on separate days, and at different times of the day in outpatient clinics were recorded. Results: When the complaints of the patients were analyzed, upper respiratory tract infections were observed as the most frequent causes of hospital referrals. It has been indicated that any tests had not been required from majority of the patients, and if required, most of them were audiological tests. Prescriptions were written for the treatment of upper respiratory tract infections, and follow-up visits were not recommended for half of the patients. Conclusion: As deduced from this study, primary, and secondary health care services provide 1/3, and 2/3 of otorhinolaryngology services in the rural areas of Turkey.