Difficult septal deviation cases: open or closed technique? [Casos difíceis de desvio septal: técnica aberta ou fechada?]

Introduction The aim of this study is to compare the functional aspects of open technique (OTS) and endonasal septoplasty (ENS) in “difficult septal deviation cases”. Methods 60 patients with severe nasal obstruction from S-shaped deformities, multiple deformities, high deviations etc. were included in the study. The OTS was used in 30 patients and the ENS was performed in 30 patients. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at first month following surgery. Patients were also evaluated for pain postoperatively with Visual Analog Scale (VAS). Results The mean NOSE score was decreased 62.5–11.0 in the OTS group and 61.3–21.33 in the ENS group. Improvement of the symptoms following the two surgical techniques is similar and no statistically significant difference was found between both techniques. Also there was no statistically significant difference in postoperative pain between the OTS and ENS groups evaluated by VAS. Conclusion ENS is as successful as the OTS in management difficult septal deviation cases. In patients with severe septal deformities type of the surgical technique should be selected according to the surgeon's experience and the patient's preference. © 201

The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery

To investigate the effects of surgery type [intact canal wall (ICW) or canal wall down (CWD) mastoidectomy] and different ossiculoplasty materials on hearing outcome in single-staged cholesteatoma surgery. A retrospective case–control study. A total of 116 cases (97 adults, 29 children) underwent surgery, including ossiculoplasty, between 2012 and 2015 for cholesteatoma. Patients who had undergone surgery for the first time, and whose grafts were successful, were included in the study. Patients with adhesive otitis media, unsuccessful grafts, revision and recurrent cases, radical mastoidectomy, and craniofacial anomalies were excluded. Audiogram examinations of the enrolled patients were performed 3–6 months after surgery, and the audiometric results were analyzed according to the criteria of the American Academy of Otolaryngology, Head and Neck Surgery. All ossiculoplasties were performed during the first operation. The preoperative average air–bone gap (ABG) of the patients was decreased from 31.37 ± 10.1 to 27.42 ± 10.4 dB; this decrease was found to be highly significant (p = 0.0001). Concerning the ICW technique, statistical evaluation of the hearing gain at frequencies of 500, 1000, and 2000 Hz, as well as the mean frequency, showed a high level of significance. Improvement at 4000 Hz was not found to be statistically significant. When the ABGs at 500, 1000, 2000, and 4000 Hz, and the mean frequency in patients with an hydroxyapatite-partial ossicular replacement prosthesis (HA-PORP) or autograft-partial ossicular replacement prosthesis (APORP), were evaluated, it was found that, at 4000 Hz, the APORP significantly reduced the ABG (p = 0.02). No significant difference was determined between patients with the hydroxyapatite-total ossicular replacement prosthesis (HA-TORP) and those with the autograft-total ossicular replacement prosthesis (ATORP) (p = 0.565). Although the use of the malleus as an APORP was found to be less effective than other autografts, the degree of advantage of using the incus, malleus, cortical bone, and cartilage did not significantly differ between materials (p = 0.152). Despite the effects of the incus, malleus, and cortical bone not differing in terms of the postoperative ABG (p = 0.160), incus usage was highly beneficial for hearing gain (p = 0.009). Despite CWD tympanoplasty affecting all frequencies, it has a particularly negative effect on the hearing threshold at 1000 Hz. In patients with partial ossicular replacement, autogenous grafts are more successful in restoring hearing at high frequencies, particularly at 4000 Hz. Although autogenous materials do not differ in terms of partial replacement effectiveness, the incus has been shown to be most effective for total replacement. © 2016, Springer-Verlag Berlin Heidelberg

Audiometric correlations with pathologies of ossicular chain in 159 ears with chronic otitis media

[No abstract available

Recovery time for inflamed middle ear mucosa in chronic otitis media

Conclusion: The present study shows that 2-3 weeks after medical treatment the status of middle ear mucosa in draining ears is similar to that of dry ears for at least 3 months.Objective: To measure the time required for an inflamed middle ear mucosa to return into optimal state after appropriate medical treatment in chronic suppurative otitis media (CSOM). To assess optimal timing for elective surgical treatment of draining ears in uncomplicated CSOM.Methods: In this prospective study, the Eustachian tube (ET) mucociliary clearance time (MCT) was used as the method to demonstrate the status of middle ear mucosa. In group 1 (28 patients) ET-MCT was measured in ears that were free of drainage for at least 3 months. In Group 2 (21 patients), ET-MCT was measured in draining ears, who responded to 10-14 days medical treatment, at presentation, after 10 days and 1 month.Results: The ET-MCT was 8.63 ± 1.32 min in group 1 and 28.96 ± 8.19 min in group 2 at presentation; and the difference was statistically significant (p < 0.001). The ET-MCT was 14.76 ± 5.11 min after 10 days and 9.31 ± 2.33 min after 1 month in group 2. The ET-MCT was indifferent between groups 1 and 2 after 1 month (p = 0.235). © 2015 Taylor & Francis

Effectiveness of caudal septal extension graft application in endonasal septoplasty [Eficácia da aplicação de enxerto de extensão septal caudal em septoplastia endonasal]

Introduction Septal deviation is a common disease seen in daily otorhinolaryngology practice and septoplasty is a commonly performed surgical procedure. Caudal septum deviation is also a challenging pathology for ear, nose, and throat specialists. Many techniques are defined for caudal septal deviation. Objective To evaluate the effectiveness of caudal septal extension graft (CSEG) application in patients who underwent endonasal septoplasty for a short and deviated nasal septum. Methods Forty patients with nasal septal deviation, short nasal septum, and weak nasal tip support who underwent endonasal septoplasty with or without CSEG placement between August 2012 and June 2013 were enrolled in this study. Twenty patients underwent endonasal septoplasty with CSEG placement. The rest of the group, who rejected auricular or costal cartilage harvest for CSEG placement, underwent only endonasal septoplasty without any additional intervention. Using the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) questionnaires, pre- and post-operative acoustic rhinometer measurements were evaluated to assess the effect of CESG placement on nasal obstruction. Results In the control group, preoperative and postoperative minimal cross-sectional areas (MCA1) were 0.44 ± 0.10 cm2 and 0.60 ± 0.11 cm2, respectively (p &lt; 0.001). In the study group, pre- and postoperative MCA1 values were 0.45 ± 0.16 cm2 and 0.67 ± 0.16 cm2, respectively (p &lt; 0.01). In the control group, the nasal cavity volume (VOL1) value was 1.71 ± 0.21 mL preoperatively and 1.94 ± 0.17 mL postoperatively (p &lt; 0.001). In the study group, pre- and postoperative VOL1s were 1.72 ± 0.15 mL and 1.97 ± 0.12 mL, respectively (p &lt; 0.001). Statistical analysis of postoperative MCA1 and VOL1 values in the study and the control groups could not detect any significant intergroup difference (p = 0.093 and 0.432, respectively). In the study group, mean nasolabial angles were 78.15 ± 4.26° and 90.70 ± 2.38°, respectively (p &lt; 0.001). Conclusion Endonasal septoplasty with CESG placement is an effective surgical procedure with minimal complication rate for subjects who have a deviated, short nasal septum and weak nasal tip support. © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facia

Risk factors for otitis media effusion in children who have adenoid hypertrophia

Objective: Many studies have shown that children with adenoid hypertrophy (AH) are more likely to have chronic otitis media with effusion (COME). However, not every child with AH has COME. In this study, we investigated the socio-demographic risk factors of children who underwent surgery for AH, including a subgroup with COME. Our aim was to identify the factors involved in the development of COME. Methods: The study population consisted of 170 pediatric patients (118 males, 52 females) who underwent adenoidectomy between 2005 and 2008. The patients were divided into two groups, those with AH alone and those with AH and COME (AH. +. COME). Major factors such as age, gender, breast-milk feeding, bottle-feeding, tobacco smoke exposure, familial predisposition, allergies, congenital diseases, and school attendance were compared between the two groups. Results: AH alone was detected in 102 of the patients, 68% of whom were male, and AH. +. COME in the remaining 68, of whom 72% were male. The mean age was 6.5 years in the AH group and 5.3 years in the AH. +. COME group. There were no significant differences between the two groups with respect to breast-feeding, bottle-feeding, familial predisposition, tobacco exposure, and allergies. However, the relationships between COME and male sex, congenital diseases, and school attendance were significant. Conclusions: COME is seen in young children with AH. Among the socio-demographic features examined in this study, only male sex, congenital diseases, and school attendance were statistically significant risk factors for COME development. © 2015 Elsevier Ireland Ltd

Bacterial cellulose as a new graft model for the Turkish delight technique in rhinoplasty: An experiment in 20 rats

We conducted an experiment to investigate the effectiveness of bacterial cellulose, a new graft material, in correcting and preventing dorsal nasal disorder in rhinoplasty. The experiment was performed on 20 Wistar albino rats. The rats were evenly divided into two groups: a fascia group and a cellulose group. In the fascia group, grafts from the conchal cartilage were removed, shredded, and then wrapped in temporal muscle fascia. In the cellulose group, shredded cartilage was wrapped in the bacterial cellulose. These shredded gristle grafts, which were also placed in a subcutaneous area at the back of the rats, were excised after 60 days. We then performed histopathology to compare the health and integrity of the cartilage and the degree of vascularization, fibrosis, and chronic inflammation in the two groups. We found a significantly greater degree of vascularization (p = 0.004) and fibrosis (p = 0.005) in the fascia group and a significantly greater degree of chronic inflammation (p = 0.023) in the cellulose group. We found no statistically significant difference between the two groups in terms of cartilage health and integrity. Our results suggest that bacterial cellulose grafting may play a role as an alternative to fascia grafting for the wrapping of shredded cartilages in Turkish delight grafting, but further investigation is needed. © 2016 Vendome Group, LLC

The role of the nasal and paranasal sinus pathologies on the development of chronic otitis media and its subtypes: A computed tomography study

Objective: This objective of this study is to evaluate the presence and the coincidence of common nasal and paranasal sinus pathologies in adults suffering from chronic otitis media (COM) and its subtypes. Materials and Methods: The study group comprised 354 ears of 177 patients who underwent tympanoplasty with or without mastoidectomy from January 2013 to February 2015 due to uni/bilateral COM. Chronic suppurative otitis media, intratympanic tympanosclerosis (ITTS), cholesteatoma, and tympanic membrane with retraction pockets constituted subtypes of COM. The control group consisted of 100 ears of 50 adult patients with aural diseases other than middle ear problems. All patients were evaluated for the evidence of mucosal disease on paranasal sinuses, the presence of concha bullosa (CB), and the angle of nasal septal deviation (NSD) and thickness of the medial mucosa of the inferior turbinate were measured by coronal computed tomography images. Results: The incidence and the angle of NSD were found significantly higher in patients with COM (P = 0.028, P = 0.018; respectively). When ears with unilateral and bilateral COM compared in term of sinonasal pathologies, CB was found higher in patients with unilateral COM (P = 0.040). The presence of CB was significantly higher in ITTS when compared to other subtypes (P = 0.028). Conclusions: Our study suggests that obstructive nasal pathologies such as NSD and CB may play a role in the pathogenesis of especially unilateral COM. However, there was no correlation between COM and inflammatory pathologies such as sinusitis. © 2017 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer - Medknow

Role of Chlamydia pneumoniae and Helicobacteria pylori in the development of tympanosclerosis

The etiology of tympanosclerosis (TS) is not known, but TS commonly develops secondary to acute and chronic otitis media (COM). Since calcification process in TS resembles that of atherosclerosis (AS), pathogens that are related to pathogenesis of AS may be involved in development of TS. This prospective and controlled study, performed at a tertiary referral center, investigated a possible relationship between the presence of Chlamydia (C.) pneumoniae and Helicobacter (H.) pylori and the development of a tympanosclerotic plaque. The presence of C. pneumoniae was examined in the surgical specimens of 62 patients (29 females and 33 males; age range 10–70 years, mean age 30.8 ± 13.3 years), including 30 patients with TS, 14 patients with cholesteatoma, and 18 patients with chronic suppurative otitis media (CSOM). The presence of H. pylori was examined in the surgical specimens of 88 patients (41 females and 47 males; age range 6–70 years, mean age 32.5 ± 14.8 years), including 35 patients with TS, 22 patients with cholesteatoma, 20 patients with CSOM, and 11 patients with otosclerosis. Tympanosclerotic plaques and control specimens from the cholesteatoma, polypoid mucosa, or mucosal portion of the perforations and stapes supra structure were examined for the presence of H. pylori and/or C. pneumoniae using real-time polymerase chain reaction analysis. The analysis demonstrated that specimens from the tympanosclerotic plaques and the other types of COM were all negative for C. pneumoniae and H. pylori. An association between C. pneumoniae or H. pylori infection and the development of TS or other types of COM could not be established. © 2015, Springer-Verlag Berlin Heidelberg

Reliability of SleepStrip as a screening test in obstructive sleep apnea patients

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder and related to multiple conditions that cause mortality in adults. In the present study, reliability of SleepStrip, a disposable screening device for detection of OSAS, is tested. In this prospective, nonrandomized double-blinded single cohort study at an academic health center, the performance of the SleepStrip in detecting respiratory events and establishing an SleepStrip score (Sscore) in domestic use were compared to the apnea-hypopnea index (AHI) obtained by the standard polysomnography (PSG) recordings in the sleep laboratory. Forty-one patients who have the PSG results participated the study and wore the SleepStrips at home. Test efficiency rate was 75% and there was a positive correlation between PSG-AHI scores and Sscores (r = 0.71, p 30 levels. The SleepStrip has 100% specificity and positive predictive values, but it also has low negative predictive and sensitivity values. The SleepStrip is not a reliable screening test in differential diagnosis among simple snorers, mild, moderate and severe OSAS patients. However, high Sscores highly indicate the presence of moderate-severe OSAS. We can safely send these patients to split-night PSG and continuous, automatic, bi-level positive airway pressure (CPAP/BPAP/APAP) titration at the same night. The SleepStrip may increase the effective use of the sleep laboratories