The Effects of Burr-Assisted Rhinoplasty on Hearing

AIM

The aim of this study is to examine the effects of the burr used for hump reduction and osteoplasty on cochlear function.

MATERIALS AND METHODS

The design of this study was prospective, randomized, and controlled. Twenty patients who underwent burr-assisted septorhinoplasty were included in the study group. The control group consisted of 20 patients who underwent septoplasty. Pure tone audiometry, distortion product otoacoustic emission test, and tympanometry were performed to determine the auditory functions.

RESULTS

No significant difference was observed between the bone conduction thresholds of the right and left ears in both groups, except for a single frequency (1000 Hz in the left ear) in the control group. There was no significant difference between the 2 groups' air conduction thresholds at frequencies of 500, 1000, 2000, 4000, 6000, and 8000 Hz preoperatively and postoperatively. In addition, the study and control group did not differ significantly in signal-to-noise ratio measurements at frequencies of 500, 1000, 2000, and 4000 Hz. The comparison of preoperative and postoperative otoacoustic emission measurement results of the study group revealed a statistically significant difference only at the frequencies of 2000 Hz in the right ear and 500 Hz in the left ear. Despite those differences, otoacoustic emissions were still present at those frequencies postoperatively.

CONCLUSIONS

Our study showed that using burrs during rhinoplasty slightly impacts hearing, but it does not cause significant hearing loss. Burr-assisted rhinoplasty appears to be a safe operation regarding the auditory functions.

Surgical Methods and Auditory Outcomes of Cochlear Implantation in Cochlear Ossification

Background: The aim of this study was to evaluate the surgical and auditory outcomes of cochlear implantation in patients with cochlear ossification.

Methods: This study comprised 54 patients with cochlear ossification who underwent cochlear implantation in the cochlear implant center of a tertiary care hospital between January 1998 and May 2019. Clinical data were evaluated including surgical findings and audiological performances. The auditory outcomes of the implanted patients were assessed through the Categories of Auditory Performance-II test and Speech Intelligibility Rating test, respectively. The outcomes of patients with cochlear ossification were compared with those of 54 patients selected for the control group who underwent implantation with no cochlear ossification.

Results: Auditory outcomes were comparable between the study group and the control group. The control group obtained significantly higher scores than those of the study group when compared using the Categories of Auditory Performance-II test and Speech Intelligibility Rating test batteries. Patients with meningitis produced poorer outcomes within the group comparisons of the study group. None of the patients experienced surgical complications. The extent of ossification was analyzed in terms of its effectiveness on audiological performance. Patients with complete ossification had significantly lower Categories of Auditory Performance-II and Speech Intelligibility Rating test scores.

CONCLUSION: Cochlear implantation is a safe and beneficial procedure, even in patients with cochlear ossification. The ossified cochlea may require varied drill techniques beyond traditional implantation surgery for the insertion of the electrode array. It is, however, still difficult to predict audiological outcomes in patients with cochlear ossification.

Quality of Life in Older Adults with Cochlear Implantation: Can It Be Equal to That of Healthy Older Adults?

Background and Objectives

This study aimed to evaluate the audiologic results after cochlear implantation (CI) in older patients and the degree of improvement in their quality of life (QoL).

Subjects and Methods

Patients over 65 years old who underwent CI at implant center in Bozyaka Training and Research Hospital were included in this study (n=54; 34 males and 20 females). The control group was patient over 65 years old with normal hearing (n=54; 34 males and 20 females). We administered three questionnaires [World Health Organization Quality of Life-BREF (WHOQOL-BREF), World Health Organization Quality of Life-OLD (WHOQOL-OLD)], and Geriatric Depression Scale (GDS) to evaluate the QoL, CI-related effects on activities of daily life, and social activities in all the subjects. Moreover, correlations between speech recognition and the QoL scores were evaluated. The duration of implant use and comorbidities were also examined as potential factors affecting QoL.

Results

The patients had remarkable improvements (the mean score of postoperative speech perception 75.7%) in speech perception after CI. The scores for the WHOQOL-OLD and WHOQOL-BREF questionnaire responses were similar in both the study and control groups, except those for a two subdomains (social relations and social participation). The patients with longer-term CI had higher scores than those with short-term CI use. In general, the changes in GDS scores were not significant (p<0.05).

Conclusions

The treatment of hearing loss with CI conferred significant improvement in patient’s QoL (p<0.01). The evaluation of QoL can provide multidimensional insights into a geriatric patient’s progress and, therefore, should be considered by audiologists.

Is Pool Water Disinfectant (Hydrogen Peroxide-Silver Composition) Ototoxic in Rats?

OBJECTIVES

The purpose of our study was to evaluate whether hydrogen peroxide and silver composition (H202-Ag) used in pool water disinfectant is ototoxic to individuals with tympanic membrane perforation.

MATERIALS AND METHODS

The tympanic membranes of both ears of 14 Wistar-type albino female rats were perforated. Since topical application was performed, the right and left ears were categorized as two subgroups (a: right ear, b: left ear). Baseline auditory brainstem response (ABR) was measured. The groups were classified according to topical applications performed as Ia (30 mg/L H202-Ag), Ib (saline), IIa (70 mg/L H202-Ag), and IIb (saline). The topical applications were performed for 30 min/day for 10 days. The ABR was measured 24 hours after the last application, and the animals were sacrificed. Bilateral temporal bones were examined using light microscopy.

RESULTS

An apparent rise in the hearing thresholds of the groups Ia and Ib was not observed. However, there was an apparent rise in the hearing thresholds of the group IIa, which supports ototoxicity. According to histopathology results, there weren't any pathological findings in groups Ia and Ib and did not display special features, but a neurotoxic effect was observed in group II.

CONCLUSION

Our study shows that the H202-Ag used in pool water disinfection can have ototoxic and neurotoxic effects, particularly at high concentrations.

Microbial biofilm formation on silicone nasal splints: optimal time for splint removal

OBJECTIVES

Biofilms are sessile communities associated with persistent infections and are resistant to conventional therapeutic strategies. They survive on the surface of various inorganic medical devices and cause serious medical problems.

METHODS

We recruited 25 patients who underwent nasal surgery between January and May 2013. All patients received silicone splints at the conclusion of the procedure. Pieces of the splints were collected 48, 72 and 96 h post-surgery and prepared for scanning electron microscopy evaluation to assess biofilm formation.

RESULTS

Biofilm was observed in 3, 14 and 25 of the 25 samples at 48, 72 and 96 h, respectively. The differences in the proportions of the samples with biofilm formation at each time point (48, 72, and 96 h) were statistically significant.

CONCLUSION

Our data demonstrated that biofilm formation on silicone splints increases significantly after 48 h following placement. Although packing may reduce complications, surgeons must consider the potential hazards of packing materials, such as biofilm formation at 48 h post-surgery.

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

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.

Double uvula in a fifty-six-year-old woman

Introduction:

Deformities of the uvula are considered as the dark area of otorhinolaryngology practice. This little and plain part of the human organism has various functions and its abnormalities might cause serious disabilities.

Case Presentation:

In our case report, we present a unique deformity of the uvula in a 56-year-old woman.

Discussion:

The aim of this report was to present a very rare condition, unique case “polyuvula”, and to review the literature regarding other uvula abnormalities.

Halitosis in otorhinolaryngology practice

Halitosis is a common and devastating condition, which may affect up to 1/3 of the population. It can be classified either as genuine halitosis, pseudohalitosis, or halitophobia. Genuine halitosis is more common and usually related to an organic pathology such as periodontitis. Malodour molecules such as sulfur compounds that arise from bacterial interactions generate the basis of oral malodour. Pathologies of the tongue, poor oral hygiene, deep caries, cryptic tonsillary hypertrophia, and postnasal drainage are also associated with halitosis. Gastro-esophageal pathologies and systemic problems are accepted as extra-oral sources of halitosis. There are various methods for the diagnosis of halitosis including objective and subjective methods. General oral hygiene recommendations and specific interventions for the related etiological factors have to be addressed in order to achieve satisfactory results after the treatment. Clinicians have to be aware of these aspects regarding this unfavorable condition to achieve the best results.

Microbial biofilm formation on silicone nasal splints: optimal time for splint removal

Objectives: Biofilms are sessile communities associated with persistent infections and are resistant to conventional therapeutic strategies. They survive on the surface of various inorganic medical devices and cause serious medical problems. Methods: We recruited 25 patients who underwent nasal surgery between January and May 2013. All patients received silicone splints at the conclusion of the procedure. Pieces of the splints were collected 48, 72 and 96 h post-surgery and prepared for scanning electron microscopy evaluation to assess biofilm formation. Results: Biofilm was observed in 3, 14 and 25 of the 25 samples at 48, 72 and 96 h, respectively. The differences in the proportions of the samples with biofilm formation at each time point (48, 72, and 96 h) were statistically significant. Conclusion: Our data demonstrated that biofilm formation on silicone splints increases significantly after 48 h following placement. Although packing may reduce complications, surgeons must consider the potential hazards of packing materials, such as biofilm formation at 48 h post-surgery.

Effects of surfactant on biofilm formation on silicone nasal splints

Biofilms are sessile communities of bacteria embedded in self-produced extracellular polysaccharide matrix and are considered to be responsible for bacterial infections in humans. Topical surfactant use on silicone nasal splints may have a preventive effect on biofilm formation. The objective of this study is to investigate the effect of surfactant-containing nasal solutions on biofilm formation over the surface of silicone nasal splints. Forty patients were randomized after septoplasty to receive surfactant-containing saline solution (group 1) or saline without surfactant (group 2). At the postoperative 48th, 72th and 96th hours, pieces of splint samples were taken and prepared for scanning electron microscopic evaluation. Biofilm formation was observed in 3, 6 and 14 of 20 samples in group 1 (surfactant used) and 3, 14 and 20 of 20 samples in group 2 (control) at 48th, 72th and 96th hours, respectively. Biofilm formation incidences of groups at 48th hour were similar (p > 0.05), whereas it was significantly lower at group 1 regarding 72th and 96th hours (p < 0.05). Surfactant-containing nasal solutions have an inhibitory effect on biofilm formation over the surface of silicone nasal splints especially after 48 h. Surfactant-containing nasal solutions may have an important role in nasal septal dressing in the future.

Influence of surface properties of Merocel® (polyvinyl acetal) and silicone nasal splints on biofilm formation

The objective of the study was to investigate biofilm formation on Merocel(®) and silicone nasal splint after nasal septal surgery. 50 patients who were scheduled to undergo nasal septal surgery were included in this study. The patients were randomized into receiving an insert of Merocel(®) or silicone splint after septoplasty. In group 1 (8 females, 17 males) and group 2 (10 females, 15 males), Merocel (®) packs or silicone splints were inserted into nasal cavities at the end of the procedures, respectively. All packs were removed 48 h after insertion, and samples were taken from the packs under sterilized conditions. Scanning electron microscopy was performed to observe biofilm formation on the surfaces of Merocel(®) and silicone splints. Biofilm formation was observed in 25 (100%) and 3 (12%) of the Merocel(®) and silicone splint samples, respectively. Our study revealed that biofilm formation on Merocel(®) packs is significantly higher than silicone splints, mainly due to the different texture and surface properties of these materials. Considering the hazardous effects of biofilm formation on humans, our observations in this study may guide surgeons to choose the most appropriate packing material after nasal septal surgery.

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.

Impact of nasal obstruction on obstructive sleep apnea

OBJECTIVES

The purpose of this study was to investigate the relationship between nasal obstruction and sleep-disordered breathing. The effect of postoperative nasal packing on sleep parameters was compared between patients with mild obstructive sleep apnea (OSA) and those with moderate/severe OSA.

STUDY DESIGN

A prospective, nonrandomized controlled study.

SETTING

Tertiary care center.

SUBJECTS AND METHODS

Participants were recruited among adult patients with a history of snoring scheduled to undergo nasal surgery from November 2009 to February 2010. All subjects underwent polysomnogram (PSG) testing within 30 days prior to surgery. Patients underwent nasal surgery and received postoperative nasal packing, and a PSG was repeated on the first postoperative night with nasal packing in place. Outcome measures included a change in respiratory disturbance index (RDI), minimum oxygen saturation, oxygen desaturation index (ODI), and duration of snoring.

RESULTS

Forty-nine patients were included in the study. Patients were stratified into 2 groups: those with RDI ≥15 (n = 23) and those with RDI <15 (n = 26). Nasal packing was found to significantly increase RDI (5.2 ± 4.0 vs 10.4 ± 10.0; P = .0001), duration of snoring (86.5% ± 13.1% vs 79.3% ± 15.3%; P = .008), and ODI (7.6 ± 7.1 vs 9.9 ± 7.4; P = .001) in patients with mild OSA but not in patients with moderate/severe OSA. Mean minimum arterial oxygen saturation was unchanged in both groups.

CONCLUSION

Postoperative nasal packing aggravated measures of OSA in patients with mild OSA but not in patients with moderate/severe OSA.