Yusuf Hidir

Facial nerve problems and hearing loss in patients with temporal bone fractures: demographic data

BACKGROUND The incidence of temporal bone fractures have increased in recent decades together with the increasing traffic and population. The aim of this study is to evaluate the cause, treatment methods, radiologic, and intraoperative findings in patients with temporal bone fractures. METHODS Thirty-five patients with temporal bone fracture who have been followed between 1992 and 2006 were retrospectively reviewed. Computerized tomography and audiometric tests were obtained. Electrophysiological evaluation of the facial nerve in patients with traumatic facial paralysis was carried by serial electromyogram (EMG). House-Brackmann grading system was used to evaluate the function of the facial nerve. Twenty-three patients underwent operation for facial paralysis or hearing loss. Results of medical and surgical therapy were documented. RESULTS Traffic crash was the most common cause (54%). Eighteen (51.4%) of patients had conductive hearing loss, 6 (17.14%) of the patients had sensorineural hearing loss, and 11 (31.42%) had normal hearing. Transient or persistent facial paralysis was detected in 24 of 35 patients (68.57%). Nineteen patients underwent partial or total facial decompression. Preoperative EMG of the majority of the operated patients revealed total axonal degeneration. The most common affected area of the facial nerve by trauma was the vertical segment (31.58%). House-Brackmann 1 and 2 grade was achieved in majority of the patients. Fourteen ossicular abnormalities were detected in 10 patients, and the abnormality was usually related to the incus. More than 10 dB air-bone gap closure was achieved in six of eight patients (75%). CONCLUSIONS Traffic crashes continue to be the main cause of temporal bone fractures. Facial paralysis caused by temporal bone trauma can be satisfactorily treated by decompression. EMG, clinical grading, and onset of the paralysis are important guides for the surgery. Restoration of the hearing can be achieved in majority of patients.

Temporalis fascia and cartilage-perichondrium composite shield grafts for reconstruction of the tympanic membrane.

Objectives We sought to compare the long-term functional results of tympanic membrane reconstruction with temporalis fascia and cartilage shield grafting. Methods This study includes 113 patients who had tympanoplasty type I tympanic membrane reconstruction between 1997 and 2007, 47 with tragal cartilage and 66 with temporalis fascia. Fourteen patients in the cartilage group and 9 patients in the temporalis fascia group also had mastoidectomy. The average follow-up was 3.2 years. The hearing threshold was calculated as the mean value of the thresholds for 500, 1,000, 2,000, and 3,000 Hz. A paired-samples t-est was used for comparison of the preoperative and postoperative air and bone conduction hearing thresholds and air-bone gaps. Results Significant recovery was found in the postoperative air conduction threshold and air-bone gap in both the temporalis fascia and cartilage groups as compared to those before surgery (p < 0.001). However, the average air and bone conduction thresholds and air-bone gap were found to be statistically different after surgery in the cartilage group as compared to those in the temporalis fascia group. There was no significant difference in hearing parameters before and after surgery in patients with or without mastoidectomy in either the cartilage group or the temporalis fascia group. Conclusions The hearing gain in patients with cartilage shield grafting was better than that in those who had temporalis fascia tympanoplasty, although experimental analysis shows loss of acoustic energy for thick and large shield cartilage grafts.

Effectiveness of hyperbaric oxygen therapy in idiopathic sudden hearing loss

The aim of this study was to investigate the efficacy of hyperbaric oxygen (HBO) therapy in idiopathic sudden sensorineural hearing loss (ISSHL) by comparing hearing gain and improvement rate in patients who have been placed on both HBO and medical treatment (MT) (37 patients), and patients who have received MT only (17 patients). Both groups were compared with reference to pure tone average (PTA) and the number of patients who experienced hearing gain. Of 37 patients (40 ears) who received HBO + MT, 24 (60 per cent) experienced > or = 10 decibels (dB) improvement in PTA compared to 13 (76.4 per cent) of 17 patients who were placed on MT only. Inter- or intra-group comparison of age stratification (< 50 and > or = 50 ages) did not produce significant differences in PTA and in the number of patients who experienced hearing gain. Although there are numerous studies showing efficacy of HBO therapy; this study did not reveal a trend in favour of HBO therapy.

Unexpected tumor incidence in surgically removed unilateral and bilateral nasal polyps.

Objective: The objective of the study was to investigate the postoperative tumor incidence on routine histopathologic examination of surgical specimens in patients who underwent endoscopic sinus surgery with the preoperative diagnosis of unilateral or bilateral nasal polyposis. Methods: Patients who underwent endoscopic sinus surgery with the preoperative diagnosis of unilateral or bilateral nasal polyposis between 2000 and 2009 were included in the study as the 2 separate groups. In both groups, tumor incidence that had been noticed on routine postoperative histopathologic examination was recorded retrospectively. Patients who had a preoperative diagnosis other than nasal polyposis, determined on biopsy, were excluded. Results: Of 251 patients included, 197 had the preoperative diagnosis of bilateral nasal polyposis, and 54 had unilateral nasal polyposis. No tumor was diagnosed on postoperative histopathologic examinations in patients with preoperative bilateral nasal polyposis. Seven patients (12.96%) with the preoperative diagnosis of unilateral nasal polyposis had tumors on postoperative histopathologic examinations. Two of these 7 patients had malignant tumors that were reported preoperatively by intranasal biopsy as inflammatory polyps. Conclusions: Diagnosis of a neoplasia is an extremely rare situation, unless there are special findings of tumor in patients with preoperative diagnosis of bilateral nasal polyposis. On the other hand, histopathologic examinations should be carried out in every case operated with preoperative diagnosis of unilateral nasal polyposis, as the tumor incidence is higher.

Intranasal Fungi and Chronic Rhinosinusitis: What is the Relationship?

Objectives: The aim of this study was to investigate the effects of intranasal fungi on chronic rhinosinusitis (CRS). Methods: Forty-one patients with CRS were included in the study. The patients were put into 2 groups, with and without intranasal fungi as detected by polymerase chain reaction, and were compared in terms of different laboratory and clinical parameters of CRS. A χ2 test was used to analyze statistical differences between the 2 groups. Results: Serum eosinophilia, eosinophilia in the nasal mucus, prick and intradermal test positivity for fungi, elevated total IgE, fungal-specific IgE, prevalence of symptoms, frequency of bronchial asthma, aspirin sensitivity, and nasal polyposis did not differ significantly between the 2 groups of patients (p < .05). Conclusions: The findings of this study failed to reveal a clear correlation between the presence of fungi in the nasal passage and various factors that are assumed to be involved in the pathogenesis or clinical course of CRS. If fungi have a role in the pathogenesis of CRS, it may be via other mediators and reactions rather than IgE and type I hypersensitivity. However, the sample size was relatively small, and further studies with more cases are needed on the same topic.

Optimum height from the roof of the choana for seeking the sphenoid ostium.

Objective: The purpose of this study was to investigate the optimum height that the sphenoid sinus ostium can be probed safely from the roof of choana in a large group of patients. Methods: The study was performed retrospectively. The 200 sphenoid ostia of the 100 patients whose thin-section computed tomography (CT) including the sphenoid sinus region, made for various reasons, were included in the study. The height of the sphenoid ostium and the skull base from the choana roof were measured on sagittal images of CT. Also, by calculating the ratio of first measurement to the second one, the location of the sphenoid ostium at the anterior wall of sphenoid sinus was determined proportionally. Results: The mean height of the sphenoid ostium from the choana roof was 10.9 (SD, 2.3) mm (range, 5.7-21.5 mm), and the mean height of skull base along the anterior wall of sphenoid sinus from the choana roof was 21.3 (SD, 3.2) mm (range, 13.3-30.6 mm). The ratio of the first measurement to the second measurement was 0.5 (SD, 0.08) (range, 0.29-0.77). Conclusions: In conclusion, under endoscopic view, the sphenoid sinus ostium can be safely probed between 13.3 mm (the minimum skull base height) and 5.7 mm (the minimum sphenoid sinus ostium height) distance upward from the choana, but determining the height of the sphenoid sinus ostium preoperatively on CTs for each patient separately will increase the chance of success in probing the sphenoid sinus.

Rate of allergic fungal etiology of chronic rhinosinusitis in Turkish population

The aim of this study is to investigate intranasal fungal incidence in Turkish patients with chronic rhinosinusitis (CRS). One hundred patients with CRS and 40 healthy subjects as a control group were included in the prospective study. Nasal lavage samples were investigated for the presence of fungus, using new culture techniques and histopathologic examination. Epidermal and intradermal hypersensitivity tests were used to find out fungal atopy. Levels of serum eosinophils, total IgE and presence of fungus-specific IgE were investigated in the blood samples. Quantitative parameters were analyzed using Pearson χ2 test. Allergic fungal sinusitis (AFS) was diagnosed in 13(13%) patients. There was no fungal growth in the control group. Eosinophilic mucin was detected in 94% of patients. Clinical and laboratory parameters of CRS were not significantly different in patient groups with or without intranasal fungi. As a result, fungal incidence was not as high as expected in Turkish patients with CRS. Furthermore, no significant correlation could be found between presence of intranasal fungus and type-1 hypersensitivity in patients with CRS.

SUBMANDIBULAR TRIANGLE MASSES

Objective The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature. Materials and Methods The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed. Results The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients. Conclusion Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

Case report: nodular fasciitis of the parotid region.

OBJECTIVE To demonstrate the clinical and histopathological features of nodular fasciitis in the parotid region. CASE REPORT A 24-year-old man presented with a palpable mass in the superior border of the parotid gland. The mass was firm and immobile, with a smooth surface. Fine needle aspiration cytology revealed proliferating fibroblasts, macrophages and adipocytes among the blood cells. Although a superficial parotidectomy was initially planned, a total excision was performed, as the mass was observed to be located in the periphery of the parotid tissue. Nodular fasciitis was diagnosed, based on the results of immunohistochemical analysis. CONCLUSION Nodular fasciitis very rarely occurs in the parotid region. These lesions grow quickly, and may be misdiagnosed as sarcoma. Trauma may play a role in their aetiology. Total excision is adequate as treatment.

Temporomandibular joint herniation into the external ear canal through foramen of Huschke

Foramen of Huschke, which is also known as the foramen tympanicum, is an anatomical variation of the tympanic portion of the temporal bone. This foramen is located on the anteroinferior aspect of the external auditory canal, posteromedial to the temporomandibular joint. Herein, a rare case of foramen Huschke with a herniation of the soft tissues around the temporomandibular joint that result in severe otalgia and its treatment are presented.