An unusual complication of otitis media: Luc's abscess

Luc’s abscess is an extremely rare complication of otitis media, caused by the spread of the middle ear infection to the subperiosteal area and its accumulation beneath the temporal muscle. Unlike other subperiosteal abscesses relating to otitis media, infection may not be associated with mastoid bone involvement. Therefore, it is defined as a benign complication of otitis media. However, its rare occurrence may lead to delayed diagnosis and treatment. Here we report a case of an 11-year-old boy diagnosed with Luc’s abscess with mastoid involvement. We discuss its clinical presentation and treatment with a review of the literature. © 2018 by The European Academy of Otology and Neurotology and The Politzer Society

Evidence-Based Medical Treatment in Peripheral Vestibular Diseases

Evidence-based medicine grades scientific research articles according to their structural specification. It represents an evidence value that we can count on for clinical applications. In this review, we evaluate our medical treatment algorithm in peripheral vestibular diseases according to evidence-based medicine rules. Benign paroxysmal positional vertigo, vestibular paroxysmia, labyrinthitis, vestibular neuritis, otosclerosis, autoimmune inner ear disease, Meniere’s disease, and migraine-associated vertigo are discussed

Ruptured petrous carotid pseudoaneurysm due to tuberculous otitis: Endovascular treatment

We report the imaging findings and endovascular treatment in an unusual case of petrous internal carotid artery pseudoaneurysm due to primary tuberculous otitis. The aneurysm was recognized and ruptured during a surgical intervention for otitis. Successful endovascular treatment of the aneurysm was performed by occlusion of the parent vessel using detachable balloon and coils

Selective window application of gentamicin + dexamethasone in Meniere’s disease

Objective: The purpose of the study is to prevent hearing loss when using intratympanic (IT) gentamicin for intractable Meniere’s disease. Materials and Methods: It is a retrospective case review study. Twenty five patients who had definite Meniere’s disease and had either selective window application or weekly IT gentamicin were included into the study. First group (selective) had dexamethasone on the round window and gentamicin on oval window during exploratory tympanotomy procedure. The second group had IT gentamicin at weekly intervals. The degree of caloric weakness (CW), average hearing level in low pitch (HLP) (250, 500, 1000, 2000 Hz) and high pitch (HHP) (4000, 6000, 8000 Hz) were compared before and after treatment. The need for further treatment was noted. Results: In the first group, the average HLP was increased from 51.6±7dB to 52.2±5.6 dB. The average HHP was increased 41.96±20.2 dB to 47.2±18.3 dB after treatment. The CW changed from 37.6±23.9% to 54.6±30.6%. In the second group, the average HLP was increased from 56.3±10.5 dB to 61.65±18.3 dB. The average HHP was increased 59.05±17.4 dB to 69.4±21.98 dB after treatment. The CW changed from 45.8±22.3% to 71.53±29.63%. Both methods had statisticaly significant increase in caloric weakness. But only IT gentamicin led a significant hearing loss in HHP. Conclusion: The use of dexamethasone and gentamycin via different windows in the middle ear is safe and effective method for Meniere’s disease in the short term. Application of dexamethasone protects not only the hearing cells but vestibular cells also. © 2017 by The European Academy of Otology and Neurotology and The Politzer Society

Direct Observation of Procedural Skills in Otorhinolaryngology Training

Objective: To assess the experience on using direct observation of procedural skills (DOPS) by trainees and trainers and to evaluate its use during the training process of Otorhinolaryngology (ORL) residency.Methods: This study was designed as a prospective educational research. For the quantitative assessment, the "construct validity" of the assessment tool was examined. For the qualitative assessment, the trainees and trainers’ experiences regarding the use of DOPS in training process were investigated.Results: A total of 55 DOPS assessment forms were filled during the study. The mean observation time was 7.14±4.83 (range: 1-20) minutes, and the mean feedback time was 2.11±2.01 (range: 0.5-10) minutes. A significant difference was detected between the first year trainees and the older ones, whereas no significant difference was observed between the third, fourth, and fifth year trainees. A statistically significant, positive correlation was found between the years of education and the average score. According to the results of the qualitative assessment, the trainees stated that they realized their technical inadequacy in some procedures and it helped them to improve their skills during their residency training. The trainers confirmed that they gave feedback after each assessment. Both the trainers and trainees suggested that specific guidelines should be prepared for every procedure.Conclusion: DOPS is a useful, valid, and fair tool for assessing Otorhinolaryngology trainees. The data obtained from the DOPS forms can be used for demonstrating the success of a training clinic and to evaluate the training program

Akut allerjik rinitli hastalarda lokal sempatik sistem disfonksiyonunu gösteren lokal sempatik deri yanıtları testi’nin elektrofizyolojik çalışması

Introduction: In this study, we aimed to investigate sympathetic nervous system functions by local sympathetic skin responses of the nasal septum in patients with acute allergic rhinitis.Material and Methods: Eighty-five patients who were diagnosed as acute allergic rhinitis according to medical history and otorhinolaryngological examination with positive allergy evaluations via skin prick testing and 50 healthy subjects were included to the study. Sympathetic skin responses of the nasal septum were recorded in patients and in the control groups, and sympathetic skin response latencies and amplitudes were compared between groups.Results: The mean value of sympathetic skin response latencies was significantly longer in the patient group than that of the control group (p<0.001). In addition, mean value of sympathetic skin response amplitudes was significantly lower in the patient group than the control group (p<0.001).Conclusion: Our study is the first which electrophysiologically evaluated the local sympathetic nervous functions that shows objective evidence of local sympathetic nervous system dysfunction. This way to access local sympathetic nervous system dysfunction would be helpful in deciding patients' treatment

Detecting Intralabyrinthine Pressure Increase by Postural Manipulation with Wideband Tympanometry and Distortion Product Otoacoustic Emissions

Objective: Intracranial pressure increase is known to affect inner ear pressure through the cochlear and vestibular aqueducts. This finding forms a good model for inner ear pressure studies. Standard techniques used to detect this pressure increase are neither reliable nor easily repeatable or cheap. Studies with immitancemetry and otoacoustic emissions have been giving hopeful results. This study aims to confirm the results in the literature with wideband tympanometry and add a new parameter of otoacoustic emissions to inner ear pressure testing.Methods: Wideband tympanometry (WBT) and distortion product otoacoustic emissions (DPOAE) tests were applied to 40 healthy participants in sitting, supine, and Trendelenburg positions. DPOAE were measured under ambient or peak pressure. Resonance frequency, tympanic peak pressure, 1000, 1500, 2000, 3000, 4000, and 6000 Hz frequencies in DPOAE were measured.Results: The increase in the tympanic peak pressure and the decrease in resonance frequency (RF) due to position change were found statistically significant (p<0.01). Signal noise ratio (SNR) decrease at 1 kHz frequency and SNR increase at 2, 3, 6 kHz in the normal protocol, SNR decrease at 1 kHz in the pressurized protocol were found statistically significant (p<0.01).Conclusion: RF in WBT and 1 kHz DPOAE SNR parameters were found useful in supporting the diagnosis in pathologies that increase intracranial pressure and inner ear pressure. Future research may ease their widespread use in clinical practice as they are non-invasive and rapidly applicable

Is psychogenic dizziness the exact diagnosis?

The main goal of the study is to determine the exact ratio of pure psychogenic dizziness. Patients from vertigo outpatient clinic were evaluated by SCL-90 R questionnaire, interviews, vestibular tests and magnetic resonance imaging (when needed). Five hundred and eighteen patients were evaluated for this study. While 45.2% of the patients have at least one abnormal psychogenic scale (somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety etc.), only 9% of the patients were diagnosed as psychogenic dizziness according to the interview. One percent of 518 had no organic cause for dizziness and also diagnosed as pure psychogenic dizziness. Our results suggest that patients with dizziness need to be evaluated by psychological tests routinely and patients with high-test scores must consult a psychiatrist who is familiar with dizziness symptomatology. © Springer-Verlag 2006

Impact of multiple etiology on dizziness handicap

OBJECTIVE: Our aim was to find the ratio of multiple diagnosis in dizziness patients and to evaluate the effect of multiple etiologies on handicap level of the patient. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. INTERVENTION: The data of 703 patients (178 men and 525 women) were included in the study. Diagnoses of the patients were made in a multiple-specialty environment including otolaryngology, neurology, cardiology, internal medicine, and rehabilitation medicine. MAIN OUTCOME MEASURES: All patients filled the dizziness handicap inventory and pointed the severity of dizziness on a 10-point visual analog scale. RESULTS: Four hundred thirty-three patients (61.6%) have only one diagnosis, whereas 183 (26%) had two. Three diseases have been found in 34 patients (4.8%), and four diseases were present in eight patients (1.1%). The mean number of diagnosis in one patient was 1.32 ± 0.71. There was a significant difference between two sexes on the number of disease. There was no correlation between age and the number of diagnosis. There was no significant difference in functional scale, but the statistically significant increases are present in both physical (p < 0.05) and emotional (p < 0.01) scales. There was no correlation between age and handicap levels. CONCLUSION: Multiple diagnoses were important factors on physical and emotional handicaps. It was also found that this problem is not limited with older age group. © 2006, Otology & Neurotology, Inc