Acute Otitis Media and Facial Paralysis in an Infant with Aural Atresia: Management of a Rare Case

Aural atresia is a congenital disease that is characterized by an embryologic developmental defect of the external auditory canal (EAC). There is an erythematous, bulging tympanic membrane by otoscope in physical examination of acute otitis media (AOM). Children with aural atresia experience AOM as children have normal anatomy. However, its diagnosis is hard due to the absence of EAC. Facial paralysis is an intratemporal complication of AOM. If this complication develops in a child with aural atresia and otitis media, it makes the condition even more complicated. A 10-month old child who had such a condition is presented in this paper.

Mild and moderate COVID-19 disease does not affect hearing function permanently: a cross-sectional study ınvolving young and middle-aged healthcare givers

PURPOSE

To assess the hearing function of patients with mild and moderate COVID-19.

METHODS

The hospital staffs recovered from COVID-19 were included. The candidates who had an ear disease or progressive hearing loss prior to COVID-19, or having been hospitalised because of severe and critical COVID-19 were excluded. The age, sex, symptoms during COVID-19, and medications received for the disease were noted. The hearing thresholds (HT) of the participants who had an audiogram before having COVID-19 disease were recorded. A pure tone audiometry was conducted to all. The participants were classified into two groups; Group 1: participants who had an audiogram previously, Group 2: participants who didn't have an audiogram previously. The changes of the HTs of the participants in Group 1 were analyzed. The HTs of the participants in Group 2 were documented without any comparison. The HTs of all participants were also analyzed by classifying them into subgroups according to their symptoms during, and medications received for COVID-19.

RESULTS

Fifty-four males and 47 females (18-59 years) were included. The participants' HTs in Group 1 (n = 31) did not change significantly at any of the frequencies after having COVID-19 (p > 0.05). The pure tone averages of the participants in Group 2 (n = 70) were below 25 dB and none of the participants reported worsening of their hearing permanently. The differences between the HTs of none of the subgroups were statistically significant (p > 0.05, p > 0.05).

CONCLUSIONS

Mild and moderate COVID-19 and its treatments did not affect the hearing function permanently.

Assessment of the Effectiveness of Transcranial Magnetic Stimulation in Subjective Tinnitus

Introduction  Increases in spontaneous activity in the neurons of the auditory cortex are presumed as the pathophysiology of tinnitus.

Objective  To investigate the effectiveness of transcranial magnetic stimulation (TMS) in the treatment of tinnitus.

Methods  A total of 62 patients between the ages of 22 and 74 with chronic subjective tinnitus were enrolled in the study. The inclusion criteria were normal findings on an otolaryngologic examination and normal ranges of complete blood count, routine biochemical parameter levels, thyroid function, air-bone gap on pure-tone audiometry, and middle-ear pressure and stapedial reflex on tympanometry. The patients were randomized into 2 groups: 40 patients were placed in the treatment for TMS (tTMS) group, and the rest (22 patients) were placed in the sham TMS group. The frequency and severity of the tinnitus, as well as the tinnitus handicap inventory (THI) score of each patient were measured before and one month after the treatment, and the values were statistically evaluated.

Results  We observed a statistically significant improvement in the tTMS group ( p  < 0.05 and p  < 0.05 respectively) regarding the THI and tinnitus severity scores. The sham TMS group showed no significant improvement in terms of the THI ( p  > 0.05). However, the tinnitus severity showed a significant increase in this group ( p  < 0.05). The comparison of differences in the changes in the THI and the tinnitus severity scores showed a significant statistical improvement in the tTMS group compared with the sham TMS group ( p  < 0.05 and p  < 0.05 respectively).

Conclusion  Transcranial magnetic stimulation was found to be effective in the treatment of tinnitus, and may be adopted as a treatment for tinnitus after further comprehensive studies.

The Bibliometric Analysis of the Studies Presented at the Turkish National Otorhinolaryngology Congresses in the Period 2009-2018

Objective

The aim of this study was to quantitatively and qualitatively analyze the abstracts presented at Turkish National Otorhinolaryngology Congresses in the years from 2009 to 2018.

Methods

Abstracts were defined and grouped according to their field of study, design, level of evidence, number of authors, the main institution in which they were held, and whether they were uni- or multi-centric. Frequency and percentage tables were prepared.

Results

In total, 5,463 studies, of which 1,431 (26.2%) were oral presentations and 4,032 (73.8%) were poster presentations were reviewed. The highest number of studies was in the field of otology and in the form of oral presentations (32%), and in the field of head and neck surgery in the form of poster presentations (37%). Fifty-seven percent of all studies were conducted in university hospitals, and 34% in Training and Research Hospitals. Eighty-three percent of oral presentations and 99% of poster presentations were clinical studies. The rate of experimental animal studies was 16% in oral presentations. The most commonly used design of orally presented clinical studies was descriptive (31%), whereas prospective randomized controlled design was the least common (3%). No study with a level 1 of evidence was found. The rate of oral papers presented with evidence levels 2, 3, 4, and 5 among all oral presentations were 22%, 13%, 11%, and 54%, respectively.

Conclusion

The findings indicated that the abstracts were satisfactory in quantity, but overall scientific quality was not sufficient. The data obtained may serve as a basis for future studies, and follow-up studies may guide individuals and institutions that steer the Turkish ENT community.

Assessment of the Effectiveness of Quercetin on Cisplatin-Induced Ototoxicity in Rats

OBJECTIVES

This study aimed to evaluate the effect of quercetin on cochlear function and morphology, and its possible protective effect against acute cisplatin-induced ototoxicity in rats.

MATERIALS AND METHODS

This prospective and controlled animal study was conducted on Wistar albino rats divided into four groups. Otoacoustic emission measures were performed three days after the first infiltration in Group 1 (saline), 2 (cisplatin), and 3 (quercetin). This interval was five days for Group 4 (cisplatin+quercetin). At the end of the study, the rats were decapitated with deep anesthesia, and histological changes in the cochleas were observed by light microscopy.

RESULTS

Group 2 (cisplatin) revealed significant differences between the first and second measures in all frequencies. When compared to other group, the difference of the changes in Group 2 statistically significantly decreased, especially in higher frequencies. Morphologically, there were no acute changes in Group 1 and Group 3. Outer hair cell loss and the degeneration of stria vascularis and spiral ganglion were observed in both Groups 2 and 4; the damages in the latter were lesser.

CONCLUSION

Quercetin does not have negative effect on cochlea, and it has protective effect on cisplatin-induced ototoxicity.

Mean platelet volume, neutrophil- and platelet to lymphocyte ratios are elevated in vestibular neuritis

AIM

To evaluate the alterations in inflammatory markers, NLR and PLR, as well as mean platelet volume (MPV) and the other parameters of complete blood counts (CBC) in adult patients with vestibular neuritis (VN).

METHOD

Designed as a case control study. The records of the patients, who were hospitalized due to an acute onset vertigo, and diagnosed as VN, were analysed retrospectively. The complete blood count (CBC) measures of the patients were statistically compared with the measures of healthy subjects. The correlations between the length of hospitalization and the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were also analysed.

RESULTS

One hundred four patients with VN and 138 healthy controls were included. MPV, white blood cell and neutrophil counts, NLR and PLR were significantly higher; while lymphocyte count was significantly lower in the VN group (p < 0.001). There were no correlations between the length of hospitalization and NLR or PLR.

CONCLUSION

The elevations of NLR and PLR support the role of inflammation in VN. The high level of MPV indicates the possible role of the vascular thrombosis in the etiology of VN.

Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis

INTRODUCTION

Mucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections.

OBJECTIVE

The aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis.

METHODS

Forty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed.

RESULTS

Patient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p<0.05).

CONCLUSIONS

Unique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate.

Effects of Dexmedetomidine Infusion During Sevoflurane Anesthesia on Otoacoustic Emissions

Background and Objectives

Knowing the ototoxic potential of the agents used in medical treatments is important for the protection of hearing. Although we have knowledge regarding some effects of dexmedetomidine, which is an anesthetic-sparing drug, its influence over the hearing system has never been studied and is obscure yet. The aim of this study is to determine the effects of intravenous dexmedetomidine application during sevoflurane anesthesia on otoacoustic emissions (OAEs).

Subjects and Methods

This prospective randomized study was performed on 60 patients (34 male, 26 female, mean age: 30.6±9.2 years) who were scheduled for an elective surgery under general anesthesia and the patients were enrolled and randomly divided into 2 groups. They received dexmedetomidine (Group D) or Saline (Group S) infusion during a standardized Sevoflurane anesthesia. Transient and distortion product OAEs were measured preoperatively and postoperatively (24th hour). OAE results were compared within and between groups.

Results

In group D postoperative OAEs were lower than preoperative OAEs and postoperative levels of group S, especially at low frequencies (p<0.05).

Conclusions

Dexmedetomidine infusion affects the micromechanical function of cochlea especially in the low-frequency region. Dexmedetomidine should be carefully used during general anesthesia to avoid its probable harmful effects on cochlear micromechanics.

The Role of Trace Elements in Tinnitus

In this study, we aimed to investigate the role of three trace elements, namely, zinc, copper, and lead, in tinnitus by analyzing the serum level of copper and lead and both the serum and tissue level of zinc. Eighty patients, who applied to outpatient otolaryngology clinic with the complaints of having tinnitus, and 28 healthy volunteers were included. High-frequency audiometry was performed, and participants who had hearing loss according to the pure tone average were excluded; tinnitus frequency and loudness were determined and tinnitus reaction questionnaire scores were obtained from the patients. Of all the participants, serum zinc, copper, and lead values were measured; moreover, zinc levels were examined in hair samples. The levels of trace elements were compared between tinnitus and control groups. The level of copper was found to be significantly lower in the tinnitus group (p = 0.02), but there was no significant difference between the groups in terms of the levels of zinc, neither in serum nor in hair, and lead in serum (p > 0.05). The lack of trace elements, especially that of "zinc," have been doubted for the etiopathogenesis of tinnitus in the literature; however, we only found copper levels to be low in patients having tinnitus.

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study

Objectives

To identify the optimal pharmacological method of preparing patients for nasal endoscopy.

Methods

Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded.

Results

The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically.

Conclusion

Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

Thyroid leiomyosarcoma: presentation of two cases and review of the literature

Introduction

Leiomyosarcoma is a tumor which is rarely seen in the thyroid gland. The diagnosis may be difficult and the treatment is controversial.

Objective

The objective of the study is to review the literature about a rare malignant disease of the thyroid gland which has high mortality.

Methods

Two cases of thyroid leiomyosarcoma are presented and the previous 23 cases in the current literature are reviewed.

Results

A total of 25 cases of thyroid leiomyosarcoma are reviewed; the most common complaint was rapidly growing anterior neck mass, and ten of the 25 patients had distant metastasis at the initial admission. Fifteen of the 25 patients died with the disease in the first 12 months after the diagnosis.

Conclusion

The differential diagnosis of thyroid leiomyosarcoma is important and should be performed with other malignancies of the gland, especially with anaplastic carcinoma. The prognosis is poor and there is no consensus regarding the treatment.

Ectopic salivary gland of the base of the tongue: a rare cause of neonatal respiratory distress

Neonatal upper airway obstruction is a life-threatening condition and requires rapid assessment and effective treatment. Malformations of the upper airway of a newborn can lead to acute respiratory distress. The aim of the present paper is to report the case of a newborn with respiratory distress due to a tongue base mass, which was removed surgically. The patient needed a tracheostomy tube for only three days and then could breathe spontaneously. However, he had swallowing problems, which decreased gradually over 9 months. Histopathologically, the mass was found to consist of mucous salivary glands, and was recorded as an ectopic salivary gland, which is extremely rare among the types of masses that may cause upper airway obstruction in a newborn.