Yavuz Uyar

Effectiveness of MeroGel hyaluronic acid on tympanic membrane perforations

Conclusions. Our results support the proposition that hyaluronic acid (HA) provides a moist wound-healing environment to aid in the healing process of tympanic membrane perforation. A single MeroGel administration can be effective as well as daily topical HA application in the treatment of tympanic membrane perforations. A single application of esterified HA may be more suitable for patients and also for otolaryngologists. Objective. The purpose of the present study was to evaluate the effectiveness of a single MeroGel application on traumatic tympanic membrane perforations in rats. Materials and methods. The posterior quadrant of the tympanic membranes in both ears of 24 male pathogen-free Sprague-Dawley rats was perforated with a 20-gauge needle. Subjects were divided into two groups: MeroGel and daily topical HA-treated groups. All subjects were sacrificed and histopathological examinations of the tympanic bullas were carried out. Results. Perforations of controls, and MeroGel- and daily HA-treated groups closed in 17/24 (70.8%), 11/12 (91.7%), and 12/12 (100%) ears, respectively. There was a significant difference between control and MeroGel-treated groups, and also between control and daily topical HA-treated groups for the presence of vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), lymphocytes and collagen fibrils (p<0.05), whereas there was no significant difference between MeroGel- and daily topical HA-treated groups (p>0.05).

Comparative evaluation of different miniplates for internal fixation of mandible fractures using finite element analysis.

PURPOSEnIn this computer-based study, finite element analysis (FEA) was performed to assess the most suitable shape and fixation technique for a certain type of mandible fracture at corpus.nnnMATERIALS AND METHODSnA model of the mandible was prepared using computed tomography (CT) scans. The CT scans were transferred and converted to the finite element model by means of a procedure developed for this study. Simulated corpus fractures were fixed with 14 different fixation configurations of titanium miniplates. The FEA was performed with respect to displacement and stresses in the titanium miniplates for these configurations.nnnRESULTSnThe study results indicated that the use of 2 straight miniplates is more rigid than other fixation types. Fixation with only 1 miniplate at the inferior location resulted in mobility greater than the set limit of 150 microm. With L and T shaped miniplates and a straight miniplate at the middle location, fracture mobility was approximately equal to or less than the limit; however, displacement nearly reached to limit. Superior fixations with only 1 miniplate resulted in mobility lower than the limit. But these configurations exceed the yield limit of titanium miniplate.nnnCONCLUSIONSnFEA may be useful in evaluation of other plate constructs, fracture types, and fracture sites, as confirmed by the agreement between our data and those in the literature and with clinical experience. This analysis should permit us to suggest and evaluate new miniplate designs and enable considerable savings to be made in terms of time, material, and animal experiments in the future development of osteosynthesis materials and techniques.

Juvenile Ossifying Fibroma of the Mandible: a Case Report

ABSTRACT Background Fibro-osseous lesions of the jaws, including juvenile ossifying fibroma, pose diagnostic and therapeutic difficulties due to their clinical, radiological and histological variability. The aim of this study was to report the outcome of a 9 years old girl with diagnosed juvenile ossifying fibroma treatment. Methods A 9 years old girl presented with a 6 x 8 cm sized hard fixed tumour on right ramus and corpus of the mandible. On the radiological examination tumour showed an irregular but well bordered, unilocular and expansive lesion on the right corpus and ramus of the mandible. There was no teeth displacement or teeth root resorbtion. Microscopically, the tumour had trabeculae, fibrillary osteoid and woven bone. After the clinical, radiological (panoramic radiography, computed tomography and magnetic resonance imaging) and histologic analysis it was diagnosed juvenile ossifying fibroma. In the history of the patient there has been an acute lymphocytic leukaemia in the remission for 3 years. Results Because of large size of mandibular tumour, resultant expansion and destruction of mandibular cortex, the patient underwent right hemimandibulectomy using transmandibular approach. There was no recurrence or complications for two years follow-up. Conclusions Although juvenile ossifying fibroma is an uncommon clinical entity, its aggressive local behaviour and high recurrence rate means that it is important to make an early diagnosis, apply the appropriate treatment and, especially, follow-up the patient over the long-term.

Effectiveness of corticosteroids in otitis media with effusion: an experimental study.

OBJECTIVEnThe aim of the present study was to investigate the dose-related effectiveness of corticosteroids in the management of otitis media with effusion, by using the objective assessment techniques of tympanometry and cytokine measurement.nnnMATERIALS AND METHODSnThe eustachian tubes of 42 male rats were obstructed. Thirty-six subjects with effusion were randomly divided into three equal groups: controls; 0.5 mg/kg/day corticosteroid; and 1 mg/kg/day corticosteroid. Concentrations of interleukin-1beta and tumour necrosis factor alpha in the middle-ear effusions were analysed using enzyme-linked immunosorbent assay.nnnRESULTSnAn effusion occurred on the 14th post-operative day and was present on the 30th post-operative day in the control group. Otomicroscopic examination and tympanometric measurement showed an improvement in the intervention groups. There was a significant difference between both intervention groups and the control group for both interleukin-1beta and tumour necrosis factor alpha concentrations (p 0.05).nnnCONCLUSIONnThe study confirmed a short term beneficial effect of systemic steroids on resolution of otitis media with effusion in a rat model. Our results support the theory that corticosteroids significantly decrease concentrations of both interleukin-1beta and tumour necrosis factor alpha. In our model, the 0.5 mg/kg corticosteroid dose was as effective as the 1 mg/kg corticosteroid dose. Further studies should be carried out to determine the optimal dose and duration of corticosteroids in the treatment of otitis media with effusion.

Anterior atticoantrostomy for cholesteatoma surgery.

Objectives: We aimed to investigate the long-term results of anterior atticoantrostomy in adult patients with cholesteatoma. Methods: A total of 83 ears in 78 patients were operated on by the anterior atticoantrostomy technique, supported by a periosteal flap, between 1991 and 2002. Results: Cholesteatoma recurred in only 4 ears (4.8%). In the 79 ears without recurrence, re-perforation was observed in 3 ears (3.8%), and retraction pockets developed in the attic of 5 ears (6.3%), 2 of which needed ventilation tubes. Absorption or migration of cartilage grafts was not seen in any of the patients. The mean air-bone gap was 34.8 ± 13.4 dB and 16.9 ± 14.7 dB, and the mean high-tone bone conduction was 19.0±6.2 dB and 21.1 ±6.6 dB, in the preoperative and postoperative periods, respectively. Conclusions: In the reconstruction of the posterior canal wall, a cartilage graft supported by a periosteal flap prevents attic retraction and may increase the vascularization of the graft. After anterior atticoantrostomy, the recurrence rate and the probability of leaving residual tissue are low. Therefore, we believe that anterior atticoantrostomy is a relatively safe and effective technique that can be used in the management of cholesteatoma.

Glomangioma of the middle ear.

A 62-year-old female was admitted to our clinic in October 1999 with a 6-year history of hearing loss, tinnitus and otorrhea in the right ear. Physical examination showed a polypoid mass arising from the right middle ear and extending into the external auditory canal. Serohemorrhagic otorrhea was also observed. Serious hemorrhage occurred while taking a biopsy. The histopathologic diagnosis was a glomangioma. MRI demonstrated a hypervascular mass (10×15 mm2) completely filling the right middle ear. Preoperative embolization of the ascending pharyngeal artery was carried out. The tumor was completely resected via a transmastoid approach. No complications were observed postoperatively. At the most recent follow-up examination, 72 months after the operation, no sign of disease was present. The modified radical mastoidectomy approach used in this case proved to be a safe and efficacious method for removing the glomangioma.

Biocompatibility of vitallium as ossicular reconstruction material in the middle ear

CONCLUSIONnAlthough long-term data will be necessary for confirmation, the result of this preliminary study indicates that vitallium may be a good alternative material for ossicular replacement prostheses in the middle ear.nnnOBJECTIVESnTo investigate the biocompatibility of vitallium (Co-Cr-Mo) as ossicular reconstruction material in the rabbit middle ear, and to compare the results with those obtained with titanium, well known as a highly biocompatible material, and non-implanted control groups.nnnMATERIAL AND METHODSnEighteen female New Zealand White rabbits were anesthetized. The tympanomeatal flap was elevated and 12 vitallium and 12 titanium implants were placed in the bulla away from the ossicles in 24 middle ears. Six rabbits were used as non-implanted controls. All animals were sacrificed under general anesthesia on the 180th day after implantation. The temporal bones were removed, fixed in 10% buffered paraformaldehyde and decalcified for a week in EDTA. Tissue samples were then prepared using an Autotechnicon and embedded in paraffin. Sections (30-microm thick) were cut with a microtome, stained with hematoxylin-eosin, von Giesons stain and fibroblast growth factor (FGF) and examined under a light microscope. The numbers of lymphocytes, collagen fibers and FGF-positive cells were determined in all three groups.nnnRESULTSnThere was no significant difference in the numbers of collagen fibers between the groups (p > 0.05). No significant differences were found in the numbers of lymphocytes and FGF-positive cells between the titanium and vitallium groups (p > 0.05). The differences in the numbers of lymphocytes and FGF-positive cells between the control and other groups were found to be significant (p <0.05).

Evaluation of Subjective Voice Changes in Seasonal Allergic Rhinitis

Objectives: Voice is a person’s main communication tool and affected by many factors, including the upper respiratory tract. The upper respiratory tract influences mainly resonation, and the nose is one of the key points. Seasonal allergic rhinitis may affect voice quality via changing resonation. This study aims to evaluate the possible changes on voice caused by seasonal allergic rhinitis subjectively. Methods: Between October 15, 2013, and January 15, 2014, 28 patients who applied to our out-patient clinic and diagnosed with seasonal allergic rhinitis were included in the study. Mean age of the patients was 28.4 and all were female. Patients were asked to complete voice handicap index 30. Control group was composed of 30 female patients who did not have seasonal allergic rhinitis. Values were analyzed in statistically nonpaired samples using Student t test. Results: The mean voice handicap index score was 16.4 in the study group and 5.5 in the control group. There was a statistically significant difference between the 2 groups (P < .05). Conclusions: Seasonal allergic rhinitis has an adverse affect on vocal quality, subjectively.

Real-time ultrasound elastography for the differentiation of malignant and benign masses in the head and neck.

Objectives The objective of this study was to evaluate head and neck masses with real-time elastography to differentiate malignant masses. Materials and Methods Between January 2011 and December 2012, a total of 51 patients with a palpable mass in the neck region were included in this study. Excisional histopathologic data were compared with elastographic results and Doppler ultrasonography. Results The study group comprised 27 males (52.9%) and 24 females (47.1%) (mean [SD] age, 41.47 [19.59] y; range, 4–80 y). Fourteen masses were malignant (27.5%) and 37 were benign (72.5%). Comparing the elastographic results of benign and malignant masses, elastographic scores of the malignant masses were significantly higher than those of the benign masses (P < 0.005). The elastographic scores were divided into 2 groups: 34 (91.9%) patients with the diagnosis of benign mass had the score of 1 to 2, whereas 9 (64.3%) patients with the diagnosis of malignant cases had the score of 3 to 4. There was a significant difference between the groups (P < 0.005). However, 2 squamous cell carcinomas (28.6%) and 1 lymphoma (8.1%) were diagnosed with an elastographic score of 1 (Table 2). This showed that even an elastographic score of 1 was not enough to issue a diagnosis of benign masses. Conclusions With improvements in the device and increased experience, this modality can become a useful tool for the routine use. However, this modality cannot be used for screening to merely provide additional information about the nature of the masses.

Efficiency of external nasal dilators in pediatric nasal septal deviation

INRODUCTIONnNasal septal deviation results from irregular development of the nasomaxillary complex and trauma. Treatment of nasal septal deviation in pediatric patients is one of the biggest challenges in rhinology. Surgery may alter craniofacial growth patterns, and so it may be indicated only in the selected cases. The use of external nasal dilators is a relatively new treatment modality in nasal obstruction.nnnOBJECTIVEnThis study was performed to assess the efficacy of external nasal dilator in pediatric nasal septal deviation patients.nnnMETHODSnSeventy-six children who were diagnosed with nasal septal deviation at our outpatient clinic were included in the study. The patients were divided into 2 groups: the external nasal dilator group was composed of 48 children that had used an external nasal dilator for at least 1 month and still been using, while the control group was comprised of 28 children that had not received any treatment and had not used an external nasal dilator. The parents of the children were asked to complete the obstructive sleep apnea 18 questionnaire. In addition, the external nasal dilator group was asked to complete the questionnaire after stopping external nasal dilator use for 2 weeks and the control group also repeated the obstructive sleep apnea 18 questionnaire.nnnRESULTSnThe obstructive sleep apnea 18 questionnaire results were significantly different between the external nasal dilator group and the control group at the beginning of the study (i.e., when patients in the external nasal dilator group were still using their dilators, P = 0.000). On the other hand, there was no difference between the 2 groups after the patients in the external nasal dilator group had stopped using their external nasal dilator (P = 0.670).nnnCONCLUSIONnExternal nasal dilator use relieved nasal septal deviation, which narrows the nasal valve. The results of this study suggest that external nasal dilator could be used in patients that are not candidates for septoplasty.