Hearing loss in Takayasu's arteritis

OBJECTIVES

Neurosensory hearing loss is well-documented in chronic autoimmune conditions such as systemic lupus erythematosus (SLE). However, the literature lacks data on the prevalence and characteristics of hearing impairment in Takayasu's arteritis (TAK). In this cross-sectional study, our principal objective was to systematically assess the auditory function of individuals diagnosed with TAK, against SLE patients and healthy controls (HC).

METHODS

Age and gender matched TAK and SLE patients followed up in a tertiary centre along with healthy controls were included in a two-phase study. In the first phase, a questionnaire on ENT symptoms was administered to the patient (TAK: n=104 and SLE: n= 151) and HC (n=174) groups. In the second phase, patients (TAK: n=53 and SLE: n=33) and HC (n=45) underwent audiometric tests.

RESULTS

The questionnaire survey revealed that both TAK and SLE patients reported hearing loss (27.9%, 25.8%, 7.4%, p<0.001), tinnitus (49%, 35.8%, 13.8%, p<0.001) and vertigo (46.2%, 33.8%, 16.7%, p<0.001) at significantly higher rates than HC. Audiometry results indicated that both TAK (30.2%) and SLE patients (18.2%) had increased hearing loss compared to HC (8.9%), however, only TAK patients were found to have significantly increased risk in age adjusted logistic regression analysis (OR= 3.915, 95%CI: 1.179-12.998, p=0.026). Hearing loss was mainly neurosensory in all groups. TAK patients were affected at both low (<6000 Hz) and high (>6000 Hz) frequencies, whereas SLE patients were affected only at high frequencies. Hearing loss was significantly associated only with older age. No association was observed with the anatomical location of vascular involvement or history of stroke.

CONCLUSIONS

Our study reveals an increased prevalence of hearing loss in TAK. Further research is crucial to uncover the underlying causes.

The uselessness of using salivary microbiota in forensic identification purposes of a person with recent antibiotic use

The detection of microbial flora changes in saliva samples because of antibiotic use through advanced molecular genetic analysis is important for forensic and clinical applications. This study aims to reveal the variability in the microbial structure of human saliva after antibiotic use with metagenomic analysis techniques from a forensic point of view. Within the scope of the study, saliva samples were collected from patients who were under the effect of regional anesthesia to be administered a standardized course of antibiotic therapy that lasted for a week. The analysis was conducted on 56 saliva samples from 14 individuals over four different time intervals. Isolation of the 16S rRNA region and PCR analysis were performed prior to sequence analysis to determine the microbiome structure of the samples at phylum, genus, and species levels. As expected, changes were observed in bacterial species found in saliva samples after administration of antibiotics and this was linked to the specific type of antibiotics that were administered. This change was statistically significant for Firmicutes, Spirochetes, and Verrucomicrobiota. Furthermore, although the oral microbiome tends to return to its former state at the phylum and genus level within a 4-week period after the start of antibiotic use, it is observed that the change, especially in some bacterial species, still continues. The findings of this study show that because of the inability of stabilization at species-level in a period of 4 weeks from the start of antibiotic use, it is not suitable to assess saliva samples at species-level for forensic identification.

The Role of Preemptive Infiltration Anesthesia in the Management of Postoperative Pain Following Septoplasty

Introduction Septoplasty is one of the most common surgical procedures in rhinology practice. Two major problems encountered after septoplasty are pain and bleeding. Preoperative administration of analgesics before the surgical stimulus, which is the main concept of preemptive analgesia, decreases postoperative pain.

Objective The present study was designed to investigate whether preincisional lidocaine infiltration to the subperichondrial area during septoplasty surgery reduced or not postoperative pain and analgesic use.

Methods The present prospective, randomized, placebo controlled, double-blind trial was conducted on 64 consecutive patients with nasal septum deviation. Patients were randomly divided into 2 groups; the study group received 2% 20 mg lidocaine/cc (n = 31), and the control group received 6 cc 0.9% NaCl (n = 33). A standard questionnaire was given to each patient to mark his or her pain score between 0 and 10 at the 1st, 3rd, 6th, 12th, and 24th hours.

Results The mean and the range of visual analogue scale (VAS) scores of the patients in the study group at the 1st, 3rd, 12th, and 24th hours were 4.03 ± 3.08 (0–10); 3.42 ± 2.39 (0–8); 2.97 ± 2.22 (0–8); 2.87 ± 2.61 (0–9); and 1.94 ± 2.06 (0–9) respectively. The mean and the range of VAS scores of the patients in the control group at the 1st, 3rd, 12th, and 24th hours were 4.12 ± 2.7 (0–10); 3.45 ± 2.4 (0–10); 2.94 ± 2.7 (0–10); 2.79 ± 2.34 (0–10); and 1.5 ± 1.8 (0–6), respectively. The statistical analysis revealed no significant difference among the groups.

Conclusion The preemptive local anesthetic administration to the incision area and under the mucoperichondrial flap before septoplasty does not decrease the level of postoperative pain.

The Efficacy of Intratympanic Steroid Injection in Tinnitus Cases Unresponsive to Medical Treatment

OBJECTIVES

To examine the efficacy of an intratympanic steroid injection in tinnitus cases unresponsive to medical treatment.

MATERIALS AND METHODS

The study was carried out at the Ear, Nose, and Throat Department with 107 patients (46 male, 61 female) between the ages of 20 and 77 with a mean of 42.8 years who had idiopathic tinnitus. Patients were randomized by simple randomization to receive intratympanic dexamethasone or isotonic solution. The patients received six intratympanic injections, two per week for three weeks. Tinnitus handicap index (THI) was performed before treatment and at first week, first month, and six months after the completion of the study protocol. The audiometric tests were performed six months after the treatment.

RESULT

In the study group, pretreatment THI and post-treatment first month THI scores and pretreatment THI and post-treatment sixth month THI scores were significantly different whereas the same scores were not significantly different in the control group. The comparison of THI scores between the groups revealed significantly lower scores in the first and sixth months for the study group.

CONCLUSION

The effect of the intratympanic injection of dexamethasone on the efficacy of treatment of tinnitus severity was statistically significant.

Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center

PURPOSE

This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not.

METHODS

Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted.

RESULTS

A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class (r = .39; P = .04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors (r = .34; P = .089 and r = .34; P = .087, respectively). Age was significantly and negatively correlated to vascular injury (r = -.51; P = .05). Vascular injury was significantly correlated with gender (male predominance: r = -.64; P = .000).

CONCLUSION

Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization.

Extra-Cochlear Insertion in Cochlear Implantation: A Potentially Disastrous Condition

OBJECTIVES

Cochlear implantation is an increasingly used technique for auditory rehabilitation of pediatric and adult population. Safe implantation is achieved in most cases; however, intraoperative complications and misplacement of the electrode are observed in some. The aim of this presentation was to review the characteristics of patients with extra-cochlear electrode insertion, postoperative diagnostic methods, and considerations in revision surgery.

MATERIALS AND METHODS

In total, 423 cases of cochlear implantation performed in our clinic between 2012 and 2018 were retrospectively analyzed and those of extra-cochlear implantation were evaluated.

RESULTS

Extra-cochlear insertion was found in 3 patients. The electrode was placed into the internal acoustic canal in the first case, superior semicircular canal in the second case, and internal carotid artery canal in the third case. Cochlear insertion was achieved in all cases with re-implantation, and no complication was observed.

CONCLUSION

This case series highlights that rare, but potentially serious, consequences of misplacement of the electrode in cochlear implantation can be successfully avoided and treated via a multidisciplinary approach.

Osteosarcoma of the Ethmoid Sinus

Osteosarcoma (OS) is a malignant bone tumor and it is very rare in head and neck region. If it arises in this area, most common localizations of this tumor are mandible and maxilla and ethmoid sinus is very rare site for this malignancy. A 43-year-old female admitted to our clinic with the complaint of pain in the right half of the face and headache persisting for 2 months. According to the clinical symptoms and imaging studies, sinonasal ossifying fibroma was suspected. For this reason, patient was operated endoscopically and histopathological examination revealed that osteoid matrix producing atypical osteoblastic cells so these findings identified osteoblastic variant OS. This article is about a very rare case of OS of ethmoid sinus. The differential diagnosis, general characteristics, and classification of this tumor, radiological features, and surgical techniques are also presented.