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Surgical treatment of eustachian tube dysfunction is still challenging. Placement of a transtympanic ventilation tube may not be successful and may require multiple applications. We presented a 47-year-old male patient with chronic recurrent otitis media with effusion and retraction due to eustachian tube dysfunction, in whom the number of previous transtympanic tube insertions amounted to 18. He underwent laser assisted eustachian tuboplasty in both ears with endoscopic guidance under general anesthesia. The mucosal, submucosal, and partially the cartilaginous tissues in the posterior pillow of the nasopharyngeal orifice of the eustachian tube were ablated by Nd:YAG and holmium:YAG laser. Following surgery, air conduction thresholds decreased from 37 dB to 22 dB, and from 38 dB to 33 dB for the right and left ears, respectively. The preoperative tympanogram curve, which was of type B for both ears was found as type C-1 on the right side, and type C-2 on the left. Limited improvement seen in the left ear was ascribed to insufficient ablation of the posterior pillow of the eustachian tube. No complications were encountered within a follow-up of 12 months.

Background: Understanding of the anterior skull base anatomy is crucial to avoid intracranial violations during endoscopic surgery. The aims of this study were to define the normative data about cribriform plate depth and the relationship between this dimension and the measurements of the adjacent anatomical structures such as middle turbinate length, maximal vertical orbital height and distance between the ethmoid roof and the nasal floor., Patients and Methods: Paranasal computerized tomographic scans of 136 healthy adults were included into the study. The cribriform plate depth compared to the ethmoid roof and the adjacent anatomical structures mentioned above were measured bilaterally., Results: The maximal vertical orbital height was detected as the most constant anatomic measurement. We found the mean level difference between the ethmoid roof and the cribriform plate as 6.1 +/- 2.3 (range 1-12 mm) on the left side and 6.1 +/- 2.2 (1-15 mm) on the right side. The middle turbinate was significantly longer in the Keros Type I group than in the other groups (p<0.05). Furthermore, the distance between the ethmoid roof and the nasal floor was lowest in the Keros Type I group (p<0.01). The distance between the ethmoid roof and the nasal floor was statistically higher in Keros group 3 among all groups (p<0.01). The deeper the cribriform plate, the higher the nasal cavity., Conclusion: To the best of our knowledge, our study has a unique feature by including the data of the constant anatomical structures comparing with the cribriform plate depth. Since in the group with excessive cribriform plate depth, the middle turbinate was short, care should be taken especially during middle turbinate resections.

Objectives/hypothesis: Chronic hepatitis B virus infection is a significant worldwide health problem. It affects 350 to 400 million people. The patients with chronic hepatitis B virus infection have a significant risk for the development of cirrhosis or hepatocellular carcinoma. Full awareness of the mechanisms of transmission can allows susceptible individuals to refrain from this infection. Cerumen has never been studied as a route for hepatitis B transmission. The aim of the study was evaluate the importance of cerumen in transmission of hepatitis B virus infection., Study Design: This study was performed on forty patients with confirmed hepatitis B virus infection., Methods: Forty cerumen specimens collected from the patients with hepatitis B virus DNA in their sera were prospectively analyzed for the presence of hepatitis B virus DNA by real-time polymerase chain reaction., Results: Eleven of 40 cerumen specimens (27.5%) were positive for hepatitis B virus DNA, with counts ranging from 4.2 x 10 to 4.7 x 10 copies per sample. There was positive correlation between hepatitis B virus DNA concentrations of serum and cerumen. Half of hepatitis B e antigen (HBeAg)-positive patients had detectable hepatitis B virus DNA levels (5.7 x 10 to 4.7 x 10 copies) in cerumen specimens, whereas 12.5% of cerumen specimens from anti-HBe-positive patients had hepatitis B virus DNA levels (4.2 x 10 to 7.0 x 10 copies)., Conclusion: Cerumen can be a potential source of transmission. Therefore, this route should be investigated in further studies for horizontal, nosocomial, and occupational transmission of hepatitis B.

Objectives: Clinical and epidemiological findings have provided evidence supporting a role of free radicals in the etiology of cancer. Scavengers and inhibitors of free radical processes have been demonstrated to prevent or delay the neoplastic process., Patients and Methods: Adenosine deaminase, xanthine oxidase, superoxide dismutase, and glutathione peroxidase activities and malondialdehyde levels were measured in the sera of 35 patients with head and neck cancers and were compared to those of healthy control subjects., Results: Serum adenosine deaminase activity was found to be significantly increased in the patient group (p<0.001). Compared to the control group, glutathione peroxidase and xanthine oxidase activities and malondialdehyde levels were slightly higher and serum superoxide dismutase activity was slightly lower in the patient group, with none reaching statistical significance., Conclusion: The results indicate that serum adenosine deaminase activity may be helpful in the diagnosis and follow-up of head and neck cancers. Further studies with a larger cohort of patients are needed to clarify the exact mechanism of adenosine deaminase elevation.

Background: Congenital nasal pyriform aperture stenosis (CNPAS) leading to respiratory insufficiency in infants has been well documented. Nevertheless, the nasal pyriform aperture stenosis (NPAS) entity in adulthood has not been discussed at all. The normative data of the width of the pyriform aperture, which has not been revealed before, is necessary for evaluation of the adult subjects with nasal bony inlet stenosis. The aim of this study was to define the normative data about the pyriform aperture width measured in 80 adult subjects with paranasal sinus symptoms without nasal obstruction and, additionally, to report the surgical results of two representative cases with NPAS., Methods: The nasal bony inlet width measurements have been achieved in axial computerized tomographic sections to establish normative data. The maximal distance between the nasal processes of the opposite maxillary bones was measured. Two adult males complaining of nasal obstruction with overt pyriform aperture stenosis were treated surgically via a sublabial approach., Results: The mean widest dimension of the nasal pyriform aperture was 21.6 +/- 2.2 mm (range, 17-27 mm) in 80 adult subjects. This width was 21.9 +/- 2.1 mm (range 18-27 mm) in men and 21 +/- 2.2 mm (range, 17-26 mm) in women. Stenotic pyriform apertures in two patients were widened surgically by drilling via a sublabial approach from 12 and 10 mm to 24 and 21 mm, respectively., Conclusion: NPAS should be included in the list of differential diagnosis for nasal obstruction. Surgical enlargement using a sublabial approach was found an effective and adequate treatment in pyriform aperture stenosis.

Tracheoesophageal puncture is a simple procedure for speech rehabilitation of total laryngectomy patients. Despite its relative simplicity this is not an innocent technique without complications. The goal of this study was to determine the incidence of acute mediastinitis as an early postoperative complication related to this procedure and to present outcomes of non-surgical conservative management in this complication. Blom-Singer voice prosthesis was used for 51 secondary tracheoesophageal puncture procedures in 45 patients between 1994 and 2002 according to the technique described by Blom and Singer. In the postoperative period, four patients (7.8%) developed mediastinitis related to this procedure. Of these, one patient had iatrogenic perforation of the posterior esophageal wall. A false dissection plane occurred in the tracheo-esophageal party wall in three patients which subsequently resulted in mediastinitis. Mediastinitis was diagnosed by clinical and radiological findings. All of these patients required prolonged hospitalization, intravenous antibiotics, and chest tube insertion. Only one patient underwent major surgical procedure to treat this complication. In conclusion, tracheoesophageal puncture for voice restoration is now regarded as a routine procedure usually performed in outpatient conditions. However, our experience demonstrates that this technique may be associated with significant complications such as mediastinitis. If mediastinitis is recognised earlier, it may be treated with conservative measures in most of the cases.

Objective: The aim of this study was to reveal the anthropometric growth of auricula from birth to the age of 18 years and to bring out the dynamics of ear growth., Material and Methods: A total of 1552 children in 50 groups were evaluated. Six surface measurements were performed directly on the right auricle of the subjects: the length from the superaurale to subaurale, the width from the tragus to helix, the width from the tragus to antihelix, the conchal depth, the height from the helix to mastoid at superauraler level, and the height from the helix to mastoid at tragal level. The frequency of prominent ear deformity and the degree of attachment of the lobule were also noted., Results: Vertical auricular growth was complete in girls at the age of 11 and in boys at the age of 12, whereas the auricular width from the tragus to helix, the height from the helix to mastoid at superauraler level and the height from the helix to mastoid at tragal level were found almost complete at the age of 6. The auricular width from the tragus to antihelix attained its full size at 6 months for girls and 12 months for boys. The conchal depth was found almost complete at the age of 5 in both sexes. The incidence of prominent ear deformity and attached lobule was 9.8 and 26.5%, respectively., Conclusions: Different ear growth pattern and maturation size from previously published reports are obtained in different populations. There is still need for future studies comparing populations with different social and ethnic background to interpret common knowledge about the size of the ear. This study gives dimensional information and the growth pattern of the auricle, and therefore may reveal important implications for the adequate timing of the surgical treatment of auricular deformity.

Objectives: We assessed the effects of endoscopic sinus surgery on quality of life of patients with nasal polyposis or chronic sinusitis., Patients and Methods: Thirty patients (5 females, 25 males; mean age 36 years; range 17 to 58 years) who underwent endoscopic sinus surgery were prospectively evaluated. The diagnoses were nasal polyposis in 15 patients and chronic sinusitis in 15 patients. Primary and revision operations were performed in 23 patients and seven patients, respectively. The quality of life was evaluated before and six months after surgery with the use of the Chronic Sinusitis Survey (CSS), and Medical Outcomes Study Short Form-12 (SF-12). Prior to administration, the two questionnaires were translated and adapted to Turkish. Computed tomography (CT) findings were scored before and six months after surgery according to the Lund-Mackay system. The results of the surveys were compared with CT scores., Results: The postoperative SF-12 and CSS scores of all the patients improved significantly. Computed tomography scores were not found in correlation with improvements in the SF-12 and CSS scores., Conclusion: Endoscopic sinus surgery results in significant improvement in the quality of life of patients with nasal polyposis and chronic sinusitis, which may not be reflected by CT scores.

Objective: Little attention has been paid to the effects of electromagnetic field (EMF) of mobile phones on hearing. The aim of this study is to investigate the effects of chronic exposure to EMF emitting from mobile phones on the inner ear of adult and developing rats using distortion product otoacoustic emissions (DPOAEs)., Methods: EMF of mobile phones exposure was scheduled according to a sham-exposure controlled experimental design. Every day seven of 14 adult and four newborn rats were exposed to 1-h mobile phone EMF for 30 days, while the other seven adult rats were assigned to control group. DPOAEs were measured in both groups before and after the chronic exposure to EMF. The newborn rats were tested following similar exposure beginning on the 2nd day after birth., Results: No measurable EMF associated changes in DPOAEs either in adult or developing rat inner ears were determined (P>0.05)., Conclusion: It was concluded that chronic exposure of EMF, as long as 30 days 1 h per day, emitting from a mobile phone did not cause any hearing deterioration in adult and developing rats, at least at outer and middle ear and cochlear levels.

Objectives: To evaluate the possible relationship between concha bullosa, nasal septal deviation and sinusitis., Patients and Methods: Paranasal sinus computed tomography scans of patients suffering from rhinosinusitis were examined. Fifty-four patients with concha bullosa were included in the study. The relationship between concha bullosa, nasal septal deviation and sinusitis was investigated., Results: A statistically significant relationship between unilateral concha bullosa and nasal septal deviation was found (p < 0.01). The relationships of unilateral and bilateral concha bullosa with sinusitis, and bilateral concha bullosa with nasal septal deviation were not statistically significant (p > 0.05)., Conclusion: In order to define the relation between the concha bullosa, nasal septal deviation and sinusitis, more detailed investigations are needed.

Background: Although many investigations have been performed on bacteriology of chronic sinusitis and normal sinuses, there still is much discussion. Also a new bacterial agent, Alloiococcus otitidis determined in the nasopharynx and middle ear specimens can be thought as a causative agent of sinusitis., Methods: The bacteriology of chronic maxillary sinusitis and maxillary sinuses with normal radiogram and endoscopic findings were studied by culture methods for aerobic and anaerobic bacteria. Multiplex polymerase chain reaction (PCR) was used to investigate four bacteria in study and control groups. There were 27 specimens in the study group and 28 specimens in the control group., Results: In the study group, the bacteria commonly isolated were Staphylococcus aureus (11.1%), alpha-hemolytic streptococci (11.1%), Streptococcus pneumoniae (11.1%), Haemophilus influenzae (7.4%), coagulase-negative staphylococci (7.4%), and anaerobes (33.3%). Coagulase-negative staphylococci (14.3%), alpha-hemolytic streptococci (10.7%), and anaerobes (35.7%) were isolated also in the control group. PCR was used to investigate S. pneumoniae, H. influenzae, Moraxella catarrhalis, and A. otitidis in the study and control groups. None of these bacteria was determined in the control group whereas detection rates of these bacteria in the study group were 11.1, 11.1, 3.7, and 7.4%, respectively. It should be considered that PCR yielded faint amplification band for A. otitidis., Conclusion: Using multiplex PCR can help to increase detection rates of bacterial etiology. Healthy sinuses are not sterile. A. otitidis may be one of the pathogens causing sinusitis.

The use of a new autologous material, the inferior turbinate bone, for nasal augmentation is presented together with surgical treatment of a 24-year-old male patient with moderately severe saddle nose deformity. In the postoperative period, no complications were observed. Photographs and three-dimensional computed tomography views obtained 13 months after the operation showed that the reconstruction area was highly free of postoperative resorption. The patient's complaints disappeared, and he was satisfied with functional and cosmetic results. Moreover, a histologic evaluation which was made to assess the depth of the glandular component showed that the inferior turbinate bone could be used over the nasal dorsum in a smoother shape, retaining its overlying soft tissue.

Objectives: We investigated the role of specific IgE assay in the diagnosis in patients found to be atopic or allergic by history and physical examination., Patients and Methods: Serum specific IgE levels were measured by the chemiluminescent assay in 143 adults (58 females, 85 males; mean age 34.3 years; range 16 to 62 years) and in 113 children (62 girls, 51 boys; mean age 10.2 years; range 5 to 16 years) with rhinitis, asthma, or dermatitis. The results were analyzed in six groups depending on the specific IgE level (no specific IgE, very low, low, moderate, high, and very high levels). The specific IgE threshold for a negative or positive result was accepted as 0.70 IU/ml. Allergen-specific IgE antibodies were sought for 35 allergens in adults, and for 19 allergens in children., Results: Specific IgE levels were positive (>0.70 IU/ml) in 92 adults (64.34%) and in 50 children (44.25%). Hypersensitivity to individual allergens ranged between 20.08% and 41.96% in adults, and between 17.70% and 28.32% in children. Fourteen adults and eight children showed sensitivity to a single allergen; the remaining patients were sensitive to at least two allergens., Conclusion: Detection of sensitivity to allergens is complementary to findings obtained by history and physical examination and may help to reveal allergic etiology in patients presenting with a similar symptom profile.

Necrotizing sialometaplasia is a benign, reactive, and self-limiting inflammatory disorder with clinical and histologic features resembling carcinoma. A fifty-eight-year-old woman presented with a firm submucosal mass on the right side of the upper lip, measuring 0.5 cm. Histopathologic examination of the incisional biopsy specimen was reported as adenoid cystic carcinoma, resulting in removal of the mass with a large excision and reconstruction of the primary site. However, final histopathologic diagnosis of the excised mass was necrotizing sialometaplasia. No recurrences occurred during a three-year follow-up. This report draws attention to the difficulty in distinguishing between necrotizing sialometaplasia and adenoid cystic carcinoma.

Although the relationship between hearing loss and hyperlipoproteinemia (HLP) or diabetes mellitus (DM) has been shown in many clinical investigations, this concept is still controversial. A prospective study was designed to search for the existence of subclinical auditory dysfunction related to HLP and DM by transient-evoked (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs) in patients with hearing levels better than 30 dB. Evoked otoacoustic emissions were utilized to investigate subclinical auditory dysfunction. Fifteen hypercholesterolemic patients (28 ears), 21 hypertriglyceridemic patients (42 ears) and 21 DM patients (40 ears) were eligible for investigation. The results of the DPOAEs and TEOAEs of the study groups were compared with the control group composed of individuals with similar ages and with normal blood lipids and glycemia. This group consisted of 22 people (44 ears). There was no difference in the existence of TEOAEs at all frequencies among the groups (P>0.05). No differences were found in the amplitudes of the DPOAES between the groups except at 4 kHz (P>0.05). The difference was caused by the hypertriglyceridemia group (P=0.014) and the non-insulin-dependent diabetes mellitus (NIDDM) group (P=0.012) when compared with the control group. The mean DPOAE amplitudes of the hypertriglyceridemic and NIDDM groups at 4 kHz were higher than those of the control group. The decreased DPOAE amplitudes at 4 kHz in hypertriglyceridemic and diabetic patients without clinical findings are compatible with the sensorineural hearing loss observed with hyperviscosity and increased noise susceptibility, as was shown before in these patients. Longitudinal investigations should be performed with otoacoustic emissions to help with the early prediction of the prospective effects of HLP and DM on the auditory system.

A twenty-year-old woman underwent right superficial parotidectomy for pleomorphic adenoma. On the 10th postoperative day she presented with a salivary fistula, for which repeated aspirations with pressure dressings were applied for a month. Despite decreases in the salivary fluid volume, reaccumulation persisted. Following aspiration of the salivary fluid, 40 units of botulinum toxin was injected into the pouch. On the second day of injection, the discharge ceased and the pouch disappeared. No side effects were observed and the patient remained symptom-free during four-month follow-up.

Objective: It was aimed to analyze the biometric changes in ipsilateral submandibular glands of patients with unilateral chorda tympani (ChT) section during otological operations, compared with change in size of the contralateral glands and with those of healthy subjects., Methods: 29 patients with unilateral complete ChT section and 29 healthy subjects with identical ages, genders, and weights to the patient group were examined ultrasonographically. The patients having a mean duration to follow-up examination of 32 months (2-84 months) were subdivided into two groups by their time to follow-up as short-term patient group (2-12 months, 14 patients) and long-term patient group (13-84 months, 15 patients). The ultrasonographic dimensions and volumes of submandibular glands were compared statistically between the groups., Results: In the patient group, the glands on the contralateral, non-operated side were found to be greater than the ipsilateral, denervated glands in terms of both paramandibular depth dimension (P<0.05) and volume (P<0.01). The differences could be determined only in long-term patient group. When comparing the submandibular glands of the patient group with those of the control group, it was found that paramandibular depth dimension and volume of the submandibular glands on the contralateral, non-operated side were statistically greater (P<0.01). There was no difference between submandibular glands on the operated side of the patient group and those of the control group (P>0.05)., Conclusion: The late (13-84 months) biometric results of ChT damage on submandibular gland were significant for increase in the size of the contralateral, non-denervated submandibular gland. An atrophying effect was not ascertained in the submandibular glands denervated parasympathetically due to the section of the ChT.

Objective: Neuromuscular blockade (NMB) is administered as part of a general anesthetic in order to keep the patient immobilized during surgery and has been known to hinder intraoperative neuromonitorization. The aim of this study was to determine the effects of different levels of NMB on electrical stimulation thresholds of the facial nerve during otologic surgery., Material and Methods: Intraoperative facial nerve monitorization was performed in 29 patients with advanced middle ear disease. Electromyographic (EMG) responses were recorded by insertion of needle electrodes into the orbicularis oris and orbicularis oculi muscles. Minimal facial nerve stimulations causing EMG responses in the facial musculature were measured during full recovery from the effects of muscular relaxants and with 25%, 50%, 75% and 100% levels of NMB. These defined NMB levels were maintained by the administration of a drip infusion of atracurium and were assessed objectively by recording the hypothenar muscle action., Results: All of the patients had detectable EMG responses of the facial musculature at the 50% and 75% levels of NMB in response to the electrical stimulation of the facial nerve. The corresponding mean stimulation thresholds were 0.10 +/- 0.08 and 0.11 +/- 0.09 mA, respectively. No responses were measured in 31% of the patients when the level of peripheral NMB was 100%., Conclusion: This study suggests that a regulated 50% level of peripheral NMB provides reliable intraoperative EMG monitoring of the facial musculature in response to electrical stimulation and adequate anesthesia, with full immobilization of the patient.

A large number of graft materials, either biologic or alloplastic, has been described in the reconstruction of saddle nose deformity to provide a structural support to the nasal dorsum and tip. Although autogenous materials are thought to be more advantageous, there is still no consensus regarding the most suitable surgical graft material for saddle nose. Each graft material presents some advantages and disadvantages. This article reviews current knowledge about graft materials used in the treatment of saddle nose deformity.

Objectives: We investigated the incidence of dural bone defects and encephalocele following radical mastoidectomy or open cavity tympanoplasty., Patients and Methods: We retrospectively evaluated 190 operations of 182 patients (97 males, 85 females; mean age 30.6 years; range 9 to 70 years) who underwent radical mastoidectomy (n=89) or open cavity tympanoplasty (n=101). Follow-up examinations included otomicroscopy. Patients with documented dural bone defects on examination or operation records were further evaluated by axial and coronal computed tomography scans of the temporal bone. Those with suspected encephalocele were studied by magnetic resonance imaging., Results: Dural bone defects were detected in 17 patients perioperatively. Of these, 14 defects were associated with chronic otitis media. Three iatrogenic bone defects were induced during obliteration of lateral sinus thrombosis. The mastoid tegmen was the most common site of defects (41%) and the most common etiologic factor was cholesteatoma (84%). Encephalocele was detected in one patient in whom radical mastoidectomy with lateral sinus obliteration was performed due to lateral sinus thrombophlebitis. Encephalomalasia was found nearby the defect area in two patients., Conclusion: Dural bone defects associated with chronic otitis media are not rare, the most common cause being cholesteatoma. Repair of dural lacerations requires watertight closure to prevent the occurrence of encephalocele.

Background: As a consequence of removal of the nasal hump, the upper lateral cartilages are separated from the septal cartilage in reductive rhinoplasty. A decrease in the nasal airway cross-sectional area and collapse of the internal nasal valve (INV) are inevitable unless additional surgical measures are taken., Objective: To determine the efficacy of the horizontal mattress bending suture in treating patients with nasal valve collapse., Methods: Each upper lateral cartilage was separately bent to a certain degree with a horizontal mattress suture following nasal dorsum reduction in the external septorhinoplasty as a preventive or corrective measure for the INV stenosis. The efficacy of this suture was assessed in 28 patients who presented with tension nose by comparing the INV angles preoperatively and 12 months postoperatively, as determined photographically by means of a rigid nasal endoscope., Results: The mean +/- SD preoperative INV angle was calculated as 9.1 degrees +/- 4.2 degrees (range, 0 degrees -18.3 degrees ). The mean postoperative INV angle was increased to 25.3 degrees +/- 3.8 degrees (range, 18.4 degrees -34.5 degrees ) (P<.001)., Conclusions: This method reconstitutes the normal anatomy of the INV, reestablishes stiffness or resistance of the nasal side walls so that they do not bend inwardly with inspiration, improves the airflow at this area, and avoids postoperative nasal valve stenosis in functional-cosmetic rhinoplasty cases that require considerable nasal hump reduction.

Maxillary sinus hypoplasia (MSH) is an uncommonly encountered condition by otolaryngologists. The computerized tomography (CT) scans provide valuable data about the anatomic details of the paranasal sinuses. MSH may be misdiagnosed as an infection or a neoplasm of the maxillary sinuses. Variations of the other paranasal structures, especially the uncinate process associated with MSH were defined. MSH shows three distinct hypoplasia patterns. Type I MSH characteristics are mild hypoplasia of the maxillary sinus, normal uncinate process and a well-developed infundibular passage. Significant hypoplasia of the maxillary sinus, hypoplastic or absent uncinate process and absent or pathologic infundibular passage are seen in Type II MSH. Type III MSH is characterized by the absence of an uncinate process and cleft-like maxillary sinus hypoplasia. In this study a series of 18 patients with MSH were presented. Twelve cases of unilateral and 6 cases of bilateral maxillary antrum hypoplasia were evaluated and 13 MSH type I, 7 MSH type II and 4 MSH type III were detected. Three ethmomaxillary sinuses, an overpneumatized posterior ethmoid cell into the orbit and the maxillary sinus were determined. Our series showed that the uncinate process anomalies related to MSH may lead to inadvertent orbital complications and therefore should be kept in mind.

An animal study was realized to investigate the possible beneficial effect of EGb 761 as an antioxidant agent on amikacin ototoxicity by measuring distortion product otoacoustic emissions (DPOAEs). Twenty-eight adult rats were grouped equally as follows. GROUP AMIKACIN: rats received amikacin 600 mg/kg/day intramuscularly between postnatal days (PND) 30 and PND44. Group amikacin/EGb 761: rats received amikacin 600 mg/kg/day intramuscularly between PND30 and PND44 and EGb 761 100 mg/kg/day orally between PND30 and PND50. Group EGb 761: rats received equivolume saline intramuscularly between PND30 and PND44 and EGb 761 100 mg/kg/day orally between PND30 and PND50. NO TREATMENT GROUP: rats received nothing. Group amikacin was found to be affected only on the last measurement day of study (PND57). The frequencies greater than 2002 Hz were significantly reduced compared with the amplitudes of PND30 (P<0.05). Group amikacin/EGb 761 was most and earliest affected by amikacin-induced ototoxicity. DPOAE amplitudes were found in this group to be decreased at 2-6 kHz starting on PND50. The results of Group EGb 761 and No treatment group were not significantly changed. For the DPOAE input/output amplitude thresholds, Group amikacin (P<0.05) and Group amikacin/EGb 761 (P<0.01) had significantly elevated thresholds on PND57, except at 5 kHz for Group amikacin (P=0,06). According to the results of the study, EGb 761 may be regarded as a facilitating drug for the development of amikacin ototoxicity. The results of the present study may warn against concomitant use of aminoglycosides, specifically amikacin, with EGb 761.

The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. Anatomically, the ear is in close proximity to the mobile telephone during use. Hearing loss due to mobile telephone use has not been described in the medical literature; however, if there is a subtle cochlear involvement, it might be detected by means of changes in evoked otoacoustic emissions (OAEs). Thirty volunteers with normal hearing were exposed to mobile telephone EMFs for 10 min and evoked OAEs were measured before and after exposure. No measurable change in evoked OAEs was detected and none of the subjects reported a deterioration in hearing level. To the best of our knowledge, this is the first study on the effects of EMFs emitted by mobile telephones on hearing. It was concluded that a 10-min exposure to the EMF emitted from a mobile telephone had no effect on hearing, at least at outer ear, middle ear and cochlear levels.

Objective: The choice of the graft in ossicular chain reconstruction during middle ear surgery for cholesteatoma is a subject still discussed on. In order to clarify the discussion of reuse of the autologous ossicles obtained during middle ear surgery for cholesteatoma, we evaluated the probability of residual disease histologically and the safety of the ossicles after autoclavization, the most promoting alternative method to eradicate residual cholesteatoma and infection on them., Methods: The specimens used in this study were eroded twenty-seven ossicles (22 incuses, 5 malleoli) which were removed from the 27 consecutive patients operated because of cholesteatomatous middle ear disease. They were grouped as follows: Group 1, Fifteen ossicles examined histopathologically directly. Group 2, Five ossicles autoclaved for 20 min at 134 degrees C and then examined histopathologically. Group 3, Five ossicles autoclaved for 20 min at 134 degrees C after mechanical surface cleaning by a fine diamond drill, examined histopathologically. Group 4, Two ossicles removed from two different patients were placed in their mastoid cavities in order to be examined after access in the second-look operation. While one ossicle was only autoclaved, the other was mechanically cleaned by a drill before autoclavization (for 20 min at 134 degrees C). The ossicles were examined histopathologically after the removal at the second stage operation performed 12 months later., Results: In Group 1, all ossicles showed evidence of periosteal thickening. Additional findings were surface cholesteatoma or epithelia in 13 ossicles, surface inflammation in 12 ossicles, granulation tissue in 10 ossicles, osteitis in six ossicles. In Group 2, all five ossicles had preserved their lamellar structure but, no vital cells were seen. The lacunes that had the osteocytes was almost completely empty. The inflammatory cells were eliminated from the ossicles. In Group 3, ossicles were found well preserved with their lamellar structures and contours, with empty lacunes and eliminated inflammatory cells. In Group 4, in two ossicles of this group the lacunes were replaced by the new migrated viable osteocytes with evidence of new bone formation and neovascularisation. No new inflammatory focus or epithelia were found on the surfaces of the ossicles. The shape and the contour of the ossicles remained unchanged., Conclusion: In cholesteatoma surgery, ossicles with minimal erosion and adequate thickness can be used after autoclavization. In this study, it was observed histopathologically that the autoclaving autologous ossicles before ossiculoplasty in cholesteatomatous middle ear is a safe and reliable method.

Surgical correction of grade III glotto-subglottic stenosis in a two-month-old girl was illustrated in a staged manner. Firstly, a silicone keel was placed via anterior thyrotomy following a tracheotomy. Secondly, laryngotracheal reconstruction was performed by interposing an autogenous thyroid cartilage anteriorly between the edges of the longitudinally divided cricoid cartilage and the upper tracheal rings. A stent was maintained for two months. The glottis and subglottis appeared patent and healed following removal of the stent. A meaningful voice and rather comfortable respiration were observed during a 13-month follow-up. The use of thyroid cartilage autograft offers many advantages in laryngotracheal reconstruction with considerably less technical difficulty.

Autoclaving of the ossicles prior to ossiculoplasty is a very important procedure in surgery of cholesteatomatous chronic otitis media. Autoclaving allows the reuse of the ossicles removed from patients with cholesteatomatous chronic otitis media as an autograft. It also allows utilization of the malleus, incus and stapes taken from cadavers or of the uneroded malleus and incus removed from patients undergoing non-functional middle ear surgery chosen carefully with detailed history and laboratory analysis. The powerful disinfecting effect of the sterilising procedures of the homografts inactivates prion proteins which cause degenerative encephalopathies. In various studies, it has been concluded that autoclaving does not alter the matrix of the bone which is responsiable for its biophysical properties, whereas it removes all viable cells within the bone and dentures the soft tissue attached to the surface of the ossicle. We have also found confirming histological results in our two previous studies published in 1999 and 2001. It is usually recommended that soft tissue on the surface of the ossicles is removed before autoclaving. It is also sufficient to autoclave the ossicles at 134 degrees C, and at 2.5 atmosphere pressure for 5 minutes in a flash autoclave. The autoclaving time of the homograft ossicles must be longer, for 20 minutes. Following the autoclaving, these homograft ossicles should be kept at pH 5.6 for 3 days, then use a solution of 0.5% formaldehyde at pH 7 and 4 degrees C for 21 days and it should be washed with physiologic saline solution three times for 7 minutes before use. Depending on the results obtained from our planned comparative experimental study, there will be no need for additional formaldehyde fixation procedure after autoclaving and the autoclaved ossicles will be used immediately without preservation in formaldehyde solution for 24 days.

The etiology of otitis media with effusion (OME) is unclear. The bacterial analyses of middle ear effusion (MEE) in OME may reveal important information regarding its etiology. Alloiococcus otitidis, Heamophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were investigated by using microbiologic culture and a multiplex PCR method in the middle ear fluid of 32 children (54 samples) with chronic OME. PCR yielded positive results in 18 (33.3%) middle ear effusions while culture resulted positive for 3 (5.6%). The PCR method detected A. otitidis in 10 (18.5%) specimens, H. influenzae in 7 (13%), M. catarrhalis in 4 (7.4%) and S. pneumoniae in 2 (3.7%) specimens. The multiplex PCR method enhances the detection rate significantly compared to that of the conventional culture method. A. otitidis is the most common detected pathogen in the MEE of the OME.

Objectives: The aim of this study was to address the multiplicity of surgical techniques and pitfalls in the treatment of twisted noses., Patients and Methods: Fifty-nine patients (43 males, 16 females; mean age 27 years; range 17 to 47 years) with vertical axis deviation of the nose were surgically treated. Thirty patients had C-type and 29 patients had I-type twisted noses. Deviation angles were measured before nd at least six months after the operation. Correction of deviations was graded according to the ideal angular values and the two groups were compared., Results: Significant correction was achieved in both types of twisted noses (p < 0.01). The results of the I-twisted noses were significantly closer to the ideal angles compared to those of the C-twisted noses (p < 0.05). Three patients underwent revision surgery., Conclusion: To correct functional and aesthetic problems in twisted noses, an external approach can be employed to straighten the nose by releasing, mobilizing, aligning and reinforcing the nasal anatomic structures. Cartilage grafts may be used to camouflage persistent deformities. C-twisted noses require more experience in, and familiarization with, a large number of surgical techniques.

Objectives: Rhinoplastic surgery is performed for the improvement in the appearance of the nose, but it should not cause any detrimental effect on the intrinsic muscles. This study was conducted to evaluate the influence of the external rhinoplasty on intrinsic nasal muscles., Methods: Twenty-one patients were operated on by external septorhinoplasty. Functions of the nasal muscles were assessed by electromyography in response to voluntary nasal movements in patients before and after surgery., Results: Postoperative electromyographic activities of the muscles were significantly less than preoperative measurements for all movements., Conclusion: Influence of the surgical incisions, alterations of the sites of origin and/or insertion of the muscles, and the postoperative healing process can be incriminated for the decreased muscular activity. Nasal muscle function requires a better appreciation and respect for the achievement of the best aesthetic and functional results. The nasal valve reconstructive procedures should be applied routinely to compensate for this inevitable muscular involvement.

Removal of the tonsils and adenoid tissue because of recurrent infection and/or respiratory obstruction is one of the most commonly performed operations. A rare complication during this intervention is subcutaneous surgical emphysema. The awareness of anaesthesiologists and otolaryngological surgeons will protect the patient from serious consequences. We report our experience with this complication and provide a review of the literature.

Cosmetic outcome of the columellar incision closure in external rhinoplasty patients has been a subject of discussion. This study was conducted to assess whether tissue adhesives provide an alternative option for sutureless closure of columellar skin incisions for cases utilizing open technique rhinoplastic surgery. One hundred and one patients undergoing external rhinoplasty were randomized to either topical application of butylcyanoacrylate or polypropylene sutures for columellar skin closure. The majority of tension on the wound edges was taken up using 5-0 chromic catgut. Cosmetic outcomes were evaluated by two otolaryngologists independently using visual analogue and Hollander wound evaluation scales in a blinded manner. There was no statistically significant difference in cosmesis between the surgeons' evaluation scores for either type or repair of the columellar incision. Since the tissue adhesive forms its own protective barrier, post-operative care is simplified. Closure with adhesives eliminates the need for post-operative suture removal requiring an extra visit that should lead to more efficient use of physician and patient time. Butylcyanoacrylate performs cosmetically as well as standard suture closure of columellar skin incision used for external rhinoplasty.

Effects of smoking and tobacco on nasal carriage and colonisation rates of Staphylococcus aureus were investigated on 368 healthy males aged between 30 and 40 years old. The study group comprised 100 non-smokers (control group), 91 smokers, and 177 cigarette factory workers (42 smokers, 135 non-smokers). Quantitative cultures were done from the nasal swabs of all participants. After identification and determination of colony counts, S. aureus strains were tested for methicillin resistance using the oxacillin disk diffusion method. The rates of nasal carriage of S. aureus were found to be 30% in the control group, 33% in smokers, and 41% in cigarette factory workers. Overall, S. aureus colonisation (> or = 500 cfu/ml) was detected in 72% of the carriers (55/76). Colonisation rates were 43%, 63%, and 85% in the carriers of the study groups, respectively. An increasing colonisation rate was detected in accordance with the increasing number of cigarettes smoked per day, and smoking period. While methicillin-resistant Staphylococcus aureus was only found in 3% of the 30 S. aureus strains isolated from the control group, its isolation rate was 20% in the 30 S. aureus isolates of the smokers, and 33% in the 72 S. aureus isolates of the cigarette factory workers. These results indicate that cigarette and/or tobacco appear to have noticeable effects on the ecology of the nose.

The internal nasal valve (INV) refers to the slit-like region between the caudal end of the upper lateral cartilage (ULC) and the nasal septum. It is the narrowest portion and primary regulator of the nasal airway. Reduction rhinoplasty decreases the nasal airway cross-sectional area and may cause symptoms, unless additional surgical measures are taken. Rhinoplasty or septorhinoplasty was performed for 76 patients with a nasal hump, using an external approach. As a consequence of the nasal hump removal, the ULCs were separated from the septal cartilage. All patients underwent one of the three forms of cartilaginous nasal dorsum reconstruction: primary closure (PC) (50 patients); spreader graft (SG) (19 patients); or upper lateral splay graft (ULSG) (7 patients). At least 3 months postoperatively. INV obstruction was evaluated by asking the patients about nasal obstruction symptoms and visually examining the INV with an otoscope. Nasal obstruction complaints and INV constriction found among patients in the PC. SG and ULSG groups were 16 (32%), 2 (10.5%) and none, respectively. The results of the PC group were compared statistically with the combined results of the SG and the ULSG groups. The patients in the combined SG-ULSG group had significantly less nasal obstruction complaints and INV angle constriction compared with the PC group. Due to the higher rate of postoperative INV stenosis. PC should be avoided. The author uses ULSG when the septal cartilage appears straight and sturdy and SGs when the straightened septal cartilage looks weak and vulnerable, since SGs not only improve the INV, but also reinforce the septal cartilage.

Iron deficiency anemia is a frequently occurring clinical disorder. Despite the suggested association with hearing loss in the literature, cochlear sequelae of iron deficiency have yielded conflicting results in experimental studies. Auditory function was tested in iron-deficient and normal male Wistar albino rats using distortion product otoacoustic emissions and auditory brainstem response audiometry for the clarification of the opposing results in the literature. Hemoglobin, hematocrit, serum iron and albumin levels were monitored to verify iron deficiency. Although dramatic differences in weight gain and blood test parameters were noted, no significant change in auditory function due to iron deficiency was detected.

The sinus tympani (ST) is a critical anatomic region of the temporal bone. It lies medial to the facial nerve, between the ponticulus and the subiculum, and therefore is not easily visualized by routine surgical approaches to the middle ear and mastoid. This limited access makes the ST a site that is notorious for residual cholesteatoma. An extensive evaluation of the anatomic dimensions of the ST was made from human temporal bones. Three hundred twenty-seven bones were examined at four standardized levels to describe the dimensions and anatomic relationships of the ST with other structures of the temporal bone. The region of the stapedial tendon was found to be the most limited anatomic substructure in the vicinity of the ST. This study demonstrates the feasibility of a retrofacial approach to the ST as an aid in eradication of otherwise hidden disease.

Cisplatin is one of the most commonly used chemotherapeutic agents. However, ototoxicity, in particular, damage to the outer hair cells of the cochlea, is one of its major side effects. Otoacoustic emissions are acoustical signals that originate from the contractile activity of the outer hair cells. They are transmitted from the cochlea to the external ear canal via the middle ear apparatus. Testing is quick, painless, objective, and non-invasive. Distortion-product otoacoustic emissions (DPOAEs) are one of the evoked types of otoacoustic emissions. They are quite sensitive to any insult to the outer hair cells, even before damage is manifested in pure tone audiometry (PTA). A patient, who was on cisplatin chemotherapy due to prostate cancer, was monitored periodically for ototoxicity using DPOAEs and PTA. DPOAEs were found to detect ototoxicity one course of chemotherapy earlier than PTA during cisplatin chemotherapy. The clinical application and sensitivity of DPOAEs in monitoring ototoxicity were discussed.

Although the traditional surgical treatment of T3 laryngeal carcinomas is total laryngectomy, we have obtained favorable survival results for selected cases with partial laryngectomy, as exemplified in the literature. Extending the indications up to ultimate limits by partial, but radical surgical techniques is the recent trend in the world, for the conservation surgery of laryngeal cancers. The primary treatment of T3 laryngeal cancers, instead of irradiation, should be surgical and, for select cases partial laryngectomy, depending on laryngeal embryological development and lymphatic drainage, may be carried out. We have performed partial laryngectomy with elective or therapeutic and radical or modified radical neck dissection for 43 T3 laryngeal carcinomas at the Department of Otolaryngology, Istanbul Medical Faculty, University of Istanbul in the years 1978-1991 and obtained 2, 3, and 5 years of survival rates, which are 89, 79.4, and 73%, respectively.