[Show abstract][Hide abstract] ABSTRACT: This study aims to evaluate our ossiculoplasty results using hydroxyapatite bone cement.
Data of 29 patients (16 males, 13 females; mean age 28 years; range 17 to 57 years) who were performed ossiculoplasty using hydroxyapatite bone cement in İzmir Katip Çelebi University Atatürk Training and Research Hospital Department of Otorhinolaryngology between January 2010 and December 2013 were retrospectively evaluated. Of the 29 operated patients, bone cement was administered in 23 patients during tympanoplasty, in two patients during open technique tympanomastoidectomy, and in four patients during exploratory tympanotomy. Hydroxyapatite bone cement was only used to repair defects between incus and stapes no longer than one third of incus long arm length. Mean follow-up time was 6.5 months (range 2-32 months).
Success of ossiculoplasty was evaluated by Belfast 15/30 dB rule of thumb. Preoperative air-bone gap was 45.1 dB (range 35-55) and postoperative air-bone gap was 17.7 dB (range 6-40). Air-bone gap was below 10 dB in six patients, between 10-20 dB in 14 patients, between 20-30 dB in seven patients, and between 30-40 dB in two patients.
Ossiculoplasty using hydroxyapatite bone cement is a safe and effective method for the repair of particularly small incus long arm defects.
No preview · Article · May 2015 · Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat
[Show abstract][Hide abstract] ABSTRACT: To compare the hearing results and graft take rates of the recently developed gold wire prosthesis with those of the hydroxyapatite partial ossicular replacement prosthesis in patients with chronic otitis media.
This retrospective study examined patients who underwent type 2 tympanoplasty with a minimum follow up of one year. The study population consisted of 32 patients in the partial ossicular replacement prosthesis group and 26 patients in the gold wire group. The main outcome measures were the graft success rate and level of hearing improvement. Complications and extrusion rates were also noted.
The graft take rate was 90.6 per cent for the partial ossicular replacement prosthesis group and 92.3 per cent for the gold wire group (p = 0.848). Pre-operatively, there were no significant differences in the air or bone-conduction thresholds between groups. Post-operatively, the mean hearing gain was 18.5 ± 14.0 dB in the partial ossicular replacement prosthesis group and 16.5 ± 10.6 dB in the gold wire group (p = 0.555). The mean air-conduction thresholds were 26.6 ± 12.4 and 32.6 ± 10.5 dB, respectively (p = 0.027), and the mean bone-conduction thresholds were 9.7 ± 7.0 and 10.4 ± 6.4 dB, respectively (p = 0.687).
The success and complication rates provided by the gold wire prosthesis seem comparable to those of the hydroxyapatite partial ossicular replacement prosthesis.
No preview · Article · Feb 2015 · The Journal of Laryngology & Otology
[Show abstract][Hide abstract] ABSTRACT: Objective: To present the results of the traumatic intratemporal facial nerve injury that have undergone facial nerve decompression by using middle cranial fossa (MCF) approach. Study Design: A retrospective study Setting: Tertiary referral center Patients and Methods: In this study, 13 patients who developed facial paralysis due to temporal bone trauma and undergone decompression by using MCF approach in Department of Otorhinolaryngology of Izmir Katip Celebi University Research and Training Hospital between January 1993 and December 2012 were presented retrospectively. Patients were assessed in terms of side, etiology, fracture type, House-Brackmann (HB) grade, electroneuronography (ENOG), electromyography (EMG), hearing loss, operation time, and the region of the injury. Results: The fracture was at the right side in 7 (53.8%) and at the left side in 6 patients (46.1%). The type of temporal bone fracture was longitudinal in 6 (46.1%), transverse in 2 (15.3%), and mixed in 5 patients (38.4%). Total axonal degeneration in EMG and ENOG were seen in all patients, who were HB grade 6 at preoperative assessment. Mean operation time was 30 days. The lesion in all patients was at the region of geniculate ganglion. There was conductive hearing loss in 7 patients (53.8%), sensorineural in 4 (30.7%), and mixed in 1 patient (7.6%); hearing was normal in 1 patient (7.6%). Seven patients (53.8%) improved to HB grade 2. Conclusion: In the light of the information obtained from HRCT, ENOG, and EMG, we believe that better results can be achieved with facial nerve decompression that is performed before 1 month, and geniculate ganglion region may be better controlled by MCF approach.
No preview · Article · Jul 2014 · Journal of Craniofacial Surgery
[Show abstract][Hide abstract] ABSTRACT: Objective
We investigated the relationship between facial canal dehiscence and intraoperative middle ear and mastoid findings in patients operated on for cholesteatoma.
We examined retrospectively 334 patients who had been operated on for cholesteatoma in Izmir Katip Celebi University, Ataturk Research and Training Hospital, ENT Clinic, between April 1997 and April 2010. The patients were examined for facial canal dehiscence according to age, gender, side of the ear , surgery type, first or revision surgery, localization of the facial canal dehiscence, spread of the cholesteatoma, with the presence of lateral semi-circular canal (LSCC) fistula and any defect in the ossicle chain, and destruction in the posterior wall of the external auditory canal(EAC).
Of the patients, 23.6% had facial canal dehiscence and detected most commonly in the right ear 28,9% and tympanic segment, 83.5% . Facial canal dehiscence was found to be 24.2-fold more common in patients with LSCC fistula and 4.1-fold more common in patients with destruction in the posterior wall of the (EAC). In patients located cholesteatoma in tympanic cavity + antrum and the tympanic cavity + all mastoid cells and with incus and stapes defect, increased incidence of dehiscence. Age, first or revision operation and canal wall down tympanoplasty (CWDT) or canal wall up tympanoplasty(CWUT) did not affect the incidence of dehiscence.
That the likelihood of facial canal dehiscence occurrence is increased in patients with LSSC fistulas, destruction in the posterior wall of the EAC, or a stapes defect is important information for surgeons.
No preview · Article · Apr 2014 · American Journal of Otolaryngology
[Show abstract][Hide abstract] ABSTRACT: Conclusions:
Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique is an effective and durable procedure for the management of patients with bilateral vocal fold immobility.
To review the long-term results of bilateral vocal fold immobility in 26 patients treated with vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique over a 6-year period.
This retrospective study examined patients with a minimum follow-up of 1 year. The main outcome measures used were the modified Medical Research Council (MRC) dyspnoea scale and the assessment of voice quality pre- and postoperatively using the Likert method.
The mean follow-up period was 23.77 ± 12.01 months. All patients reported marked symptomatic improvement in dyspnoea (p = 0.0001). The voice quality worsened as expected; however, this difference did not reach a significant level (p = 0.642). Transient microaspiration was noted in seven of the patients and resolved in 1 or 2 days. The procedure was performed for the contralateral vocal fold in one case, due to the loss of suture tension. No patient showed aspiration postoperatively or during follow-up. All patients were regularly followed up for the beginning of movement of the lateralized or contralateral vocal folds in our outpatient clinic.
No preview · Article · Nov 2013 · Acta oto-laryngologica
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the outcome in adult patients with laryngotracheal stenosis (LTS) and assessed the effect of procedures on their quality-of-life scores.
The study included 15 adult patients with LTS (11 males [73.3%], 4 females [26.7%]; mean age, 32 years [range, 10-52 years]) treated at the Department of Otolaryngology Head and Surgery Clinic, İzmir Atatürk Research Hospital, Turkey, from 1997 to 2008. Success of the surgery is evaluated by decanullation rate, Short form-36 (SF-36), and the Medical Research Council dyspnea scale.
The etiology of the LTS was intubation related in 14 cases (93.3%) and idiopathic in 1 case. According to the Myers-Cotton classification, 2 (13%), 8 (54%), and 5 (33%) patients were at stages 2 to 4, respectively. Fourteen patients had a mean follow-up of 57 months (range, 24-256 months). The stenotic segment involved 1 to 3 cm (mean, 1.7 cm) of trachea, and 2 to 5 tracheal rings (mean, 3.1) were resected. Postoperative decannulation was achieved in 13 patients (86.6%). In the short form-36 questionnaire, all of the parameters except for "role-emotional" were found to be significant (P < 0.01). The Medical Research Council dyspnea scale assessment revealed a significant (P < 0.001) decrease postoperatively.
Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected cases of advanced stenosis.
No preview · Article · Sep 2013 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: To investigate the ototoxic effect of boric acid solution prepared with different degree of alcohol.
This study was performed on 28 young albino guinea pigs. After the animals divided four groups prior to the application of the solution an auditory brainstem response (ABR) test was applied to the each animal under general anesthesia. Their tympanic membranes perforated and test solutions were administrated to the middle ear through the perforation. On 15th day, ABR measurements were carried out and comparison was made with preadministration values.
The degrees of hearing loss occurring as a result of the administration of 4% boric alcohol solutions prepared with 60° and 40° alcohol differed significantly (p<0.001).
It was established that 4% boric acid solution prepared with 60 alcohol affected hearing in guinea pigs more negatively and an increase in degree of alcohol also increased the ototoxicity of the boric acid solution.
No preview · Article · Jul 2013 · International journal of pediatric otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: Objective: We present two cases with no evidence of local or systemic disease in which the defective long arm of the incus was replaced with fibrotic tissue connected to the stapes. Case reports: A 13-year-old girl with a unilateral hearing impairment in the left ear and a 26-year-old female patient presented with hearing loss in her right ear which had been present since childhood, without ear discharge, systemic disease, trauma, or familial history was found to have intact bilateral tympanic membranes during otoscopy. The air-bone gap (ABG) was found to be 58 db in two cases. The long arm of the incus was found to be defective up to the body, and a bridge to the stapes had formed intraoperatively. The stapes was intact and mobile. Conclusion: Placing a gold-wire prosthesis between the malleus and the stapes. At 2 months post-operatively, the ABG was 10 db in two cases.
Preview · Article · Jan 2013 · International Journal of Pediatric Otorhinolaryngology Extra
[Show abstract][Hide abstract] ABSTRACT: Synovial sarcomas (SS) account for 7-8% of soft-tissue cancers and 3-5% of all cases with head and neck involvement. Synovial sarcoma of the infratemporal fossa is very rare In this article, we report the fourth case of SS of infratemporal fossa and the first case with intracranial extension via the foramen ovale. A 31-year-old man admitted with a one-year history of intense pain in his right jaw. On physical examination, there was only hyperesthesia over the right mandible side. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a mass in the infratemporal fossa and intracranial extension from the foramen ovale. The mass was surgically removed en bloc. Postoperative pathological examination reported the mass as a biphasic-type synovial sarcoma. The patient who received postoperative chemoradiotherapy had no recurrent disease for one year. The patient is still being followed in our clinic.
No preview · Article · Nov 2012 · Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effectiveness of micronized flavonoid fraction in preventing cisplatin ototoxicity in a guinea pig model.
This study was conducted on 23 guinea pigs in the Animal Laboratory of Izmir Atatürk Training and Research Hospital. Animals were divided into three groups: Group 1 consisted of eight animals receiving cisplatin only; Group 2 contained eight animals receiving cisplatin+micronized flavonoid fraction; and Group 3 contained seven animals that received micronized flavonoid fraction only. Their cochlear reserve was evaluated by measuring the distortion product otoacoustic emission on days 0 and 7.
In Groups 1 and 2, the intragroup signal-noise ratios were statistically different at all frequencies tested (based on negative ranks, p<0.05). In Group 3, the intragroup signal-noise ratios did not differ significantly at the frequencies tested (p>0.05). Comparison of the three groups showed statistically significant differences among the groups (p<0.05). The post hoc Bonferroni correction showed statistically significant differences among all three groups (p<0.016). The median signal-noise ratio of the three groups tended to increase (z-value was positive for all the frequencies tested; p<0.01).
Micronized flavonoid fraction (Daflon) is effective against cisplatin-induced ototoxicity in guinea pigs.
No preview · Article · Jul 2012 · International journal of pediatric otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: Objective To describe 2 subapproaches of the middle fossa approach: the transillumination method and transection of lines using the foramen spinosum, greater superficial petrosal nerve, and trigeminal impression to locate the malleus head for safe identification and decompression of the geniculate ganglion and facial nerve. Study Design Cadaver study. Setting A tertiary university hospital anatomy laboratory. Subjects and Methods The present study was conducted using 7 formalin-fixed cadaver heads (14 sides). A 0° endoscope was introduced into the external ear canal toward the posterosuperior quadrant of the tympanic membrane, after which transillumination was used to locate the malleus head. The brightest point indicated the convergence of the greater superficial petrosal nerve and a line drawn along the superior semicircular canal. An additional line was drawn parallel to the petrous ridge from the foramen spinosum and along the pathway of the greater superficial petrosal nerve. A third line connected the trigeminal impression to the zygomatic root. The area posterior to the intersection of these 2 lines separately with the third line was considered the zone of location of the malleus head. Among 17 patients undergoing surgery for facial paralysis between 1993 and 2011, transillumination was used in 6 patients to identify the malleus head to locate the geniculate ganglion. Results These techniques were proven to be reliable in locating the malleus head to find the geniculate ganglion in 14 dissected cadaveric temporal bones. Conclusion Two methods of locating the malleus head for facial decompression were defined.
No preview · Article · Jun 2012 · Otolaryngology Head and Neck Surgery
[Show abstract][Hide abstract] ABSTRACT: To investigate the histopathological changes and the expression of vascular endothelial growth factor (VEGF), inducible NO-synthase (iNOS), endothelial NO-synthase (eNOS), interleukin (IL)-1β, and IL-17 in the rabbit middle ear mucosa after direct gastric content exposure.
Exploratory controlled study in which histological and immunochemical features were studied after gastric content-induced inflammation was established in rabbits. Sixteen healthy rabbits were divided into two equal groups. Gastric contents of an animal were injected into the middle ear of the same animal for 20 days. Saline was injected into the middle ear of the animals in the control group. The rabbits were humanely killed on day 27. Inflammation was assayed by light microscopy. Immunochemical staining was performed for VEGF, iNOS, eNOS, IL-1β, and IL-17 expression. Experimental and control animals were examined using the same protocol.
The expression levels of VEGF, iNOS, IL-1β, and IL-17 differed significantly between the experimental and control groups (p=0.018, p=0.010, p=0.002, and p=0.002, respectively). The expression level of eNOS was not significantly different between the two groups (p=0.132).
This study demonstrates that gastroesophagial reflux induced middle ear inflammation is associated with increased expression of VEGF, IL-1β, IL-17, and iNOS.
No preview · Article · Jan 2012 · International journal of pediatric otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: Tympanosclerosis is an important sequela of otitis media. Pathologically, tympanosclerotic plaques are localized in the lamina propria between the ciliary cuboidal mucosa of the middle ear and the periosteum of the temporal bone or the squamous epithelium of the tympanic membrane.  Isolated calcified structures are also called calcospherules. They consist of calcium phosphate crystals. Many light and electron microscopic studies of the calcospherules in Basic Study / Temel Araflt›rma Özet Amaç: Atomik kuvvet mikroskobu ile kalsiyum kürecikleri oluflturan timpanosklerotik plak oluflumunu görüntüleyerek literatüre yeni bil-giler sunmak ve taray›c› elektron mikroskobuna monte edilmifl enerji yay›c› X-›fl›n› dedektörü ile temel yap›s›n› incelemek. Yöntem: Timpanoskleroz cerrahisi geçirmifl 30 hastadan al›nan ör-nekler üçüncü basamak sevk merkezimizde geriye dönük olarak ince-lendi. Atomik kuvvet mikroskobuyla en sert pla¤›n yüzey topografisi ve üç boyutlu görüntüleri analiz edildi ve taray›c› elektron mikrosko-bu – enerji yay›c› X-›fl›n› spektroskopisiyle 5 farkl› plak içindeki 5 farkl› kalsiyum küreci¤inin temel bileflimi incelendi. Bulgular: Atomik kuvvet mikroskobuyla timpanosklerotik pla¤›n üç boyutlu analizi kalsiyum fosfat kristalli oluflumlar› göstermifltir. Var olan kalsiyum, fosfat, karbon, nitrojen, oksijen, sodyum ve magnez-yum miktar›n›n tayini için enerji yay›c› X-›fl›n› spektroskopisiyle tara-y›c› elektron mikroskobu kullan›lm›flt›r. Sonuç: Timpanosklerotik pla¤›n temel bileflimi hakk›nda bilgi edin-mek için yüzey topografisi kullan›m›n›n timpanosklerozun etiyolojisi ve tedavisini anlay›fl›m›za katk›da bulunaca¤›na inanmaktay›z. Abstract Objective: To present new information to the literature by imaging the calcospherule forming tympanosclerotic plaque's structure with atomic force microscope and to analyze the elementary structure of it with energy dispersive X-ray detector adapted to the scanning electron microscope.
[Show abstract][Hide abstract] ABSTRACT: Head and neck squamous cell carcinomas readily metastasize to adjacent cervical lymph nodes. This is seen frequently in laryngeal squamous cell carcinoma (LSCC), and neck dissection may be performed in addition to excision of the primary lesion. The aim of this study was to define the frequency of level IIb metastasis to the lymph nodes in patients who underwent selective neck dissection because of LSCC.
Cross-sectional study with planned data collection in a tertiary referral hospital.
Eighty-one patients diagnosed with LSCC were accepted into the study. One hundred forty-eight neck dissection specimens were examined histopathologically, and those with level IIb metastasis were identified. The frequency of level IIb metastasis was evaluated in accordance with the primary tumor site, clinical N stage, central tumor presence, and T stage.
Forty-seven of 81 patients were clinically N-, and 34 patients were clinically N+. Level IIb metastasis was seen in 5 (6%) of 81 patients, representing 5 of 148 neck dissection specimens. Two of these 5 patients were clinically N+ (6%), and 3 were clinically N- (6%). The relationship between level IIb metastasis and clinical N stage was not statistically significant (P ≥ .05). Likewise, no statistically significant relationships between the other parameters and level IIb involvement were found.
Level IIb nodal involvement is very rare in LSCC. Therefore, the area can generally be preserved in elective neck dissection to lessen morbidity and, specifically, to avoid damaging the function of the spinal accessory nerve.
Full-text · Article · Dec 2011 · Otolaryngology Head and Neck Surgery
[Show abstract][Hide abstract] ABSTRACT: All patients treated with this new lateralization technique had a good quality of life and no dyspnea at rest or upon exertion. We believe that this technique is an important addition to the many surgical techniques for the treatment of bilateral vocal cord paralysis (BVCP).
Most techniques used in the treatment of BVCP result in a prolapse of the laryngeal soft tissues into the endolarynx owing to Bernoulli's principle. We have developed a new lateralization technique to more effectively prevent this prolapse.
The lateralization was initially tested on six cadaver larynges before being performed in five clinical cases with BVCP, who suffered from dyspnea at rest. Average follow-up was 17.6 months. As in type 1 thyroplasty, a rectangular piece of cartilage was excised horizontally from the thyroid lamina and placed on the defect in the vertical plane. Then, the vocal and ventricular folds were lateralized with crossing sutures, particularly in the posterior region.
Dyspnea was eliminated postoperatively. All patients were successfully decannulated. Postoperative voice quality was socially acceptable. Airways were improved postoperatively, as evaluated via fiberoptic laryngoscopy and CT. The mean preoperative and postoperative rima openings were 1.3 mm (range 0.5-2.6) and 6.4 mm (range 3.4-8.1), respectively.
No preview · Article · Mar 2011 · Acta oto-laryngologica
[Show abstract][Hide abstract] ABSTRACT: Objective: Ossicular chain reconstruction in chronic otitis media is still a matter of investigation. Many types of prostheses have been defined. We present biocompatibility-tested golden wire prosthesis used in the presence of a damaged or missing incus and the functional results of chain reconstruction. Materials and Methods: This report describes a prospective case review from a tertiary referral center. The study was approved by ethics committee of İzmir Atatürk Training and Research Hospital. Ossiculoplasty between the malleus and stapes was performed on a total of 20 patients, including 14 intact-wall tympanoplasty and 6 canal-wall-down tympanoplasty (CWDT) procedures. Wire prostheses were inserted between the malleus and stapes and the stapedial tendon. Pure tone average thresholds were calculated at 500, 1000, 2000, and 3000 Hz. Preoperative and postoperative air-bone gaps (ABGs) and air-conduction gains (ACs) were compared. An ABG ≤20 dB and AC ≥20 dB were accepted as successful hearing gains. Results: The placement of the prosthesis was successful in all patients. The mean follow-up period was 11.9 (3-24) months. The preoperative average ABG was 38.25 ± 11.98 dB, and the postoperative average ABG was 17.25 ± 9.92 dB. The preoperative average AC was 53.90 ± 14.99 dB, and the postoperative average AC was 34.05 ± 18.50 dB. These results were statistically significant (P = 0.001). We reached the goal of an ABG <20 dB in 9 (64.3%) of 14 patients who underwent canalwall-up tympanoplasty (CWUT) but in only 2 (33.3%) of 6 patients who underwent CWDT. This difference was statistically significant (P = 0.033). Conclusion: Despite the limited number of patients, this study demonstrated the effectiveness of the golden wire prosthesis in reconstructing the ossicular chain in the presence of a damaged or missing incus. Biocompatibility, easy accessibility and application of the golden wire, and low cost are the advantages of this technique.
No preview · Article · Jan 2011 · Journal of International Advanced Otology