Incidence and Management of Delayed Epistaxis Following Endoscopic Skull Base Surgery

Objective:Among other complications of endoscopic skull base surgery, delayed epistaxis has not been given much importance. This report presents postoperative delayed nosebleed cases in a large number of patients who underwent an endoscopic endonasal transsphenoidal approach to the sellar region for resection of lesions.Methods:Three hundred and sixty three patients who were reached to the sellar region by endoscopic endonasal transsphenoidal route and operated was included in the study. Retrospective chart reviewing of these patients was performed. The correlation between the duration of nosebleeds, bleeding location, treatment methods and comorbidities of the patients were evaluated.Results:Ten patients (3.6%) reported delayed epistaxis in the postoperative period and were referred to the otolaryngology department. Postoperative epistaxis occurred between days 7th and 33th (mean 16.5) days. The treatment consisted of chemical silver nitrate cauterization in two patients, return to the operating room in three patients, nasal packing in five patients.Conclusion:Delayed postoperative epistaxis often has no obvious etiology, and intervention requires teamworking. Well-coordinated teamworking of the neurosurgeon with other specialities such as neuroradiology and otorhinolaryngology is needed to achieve better results

Accessory Nerve Anatomy in Anterior and Posterior Cervical Triangle: A Fresh Cadaveric Study

Objective: To understand the variations and normal course of the accessory nerve (CNXI) to help more accurate and confident neck dissection.Methods: The course of the CNXI in the neck, its relationship to the surrounding anatomic structures and the factors affecting its course were investigated.Results: A total of 100 neck dissections were performed on 50 fresh cadavers. Eleven division variations were observed at the anterior triangle. The location of CNXI at the posterior border of the sternocleidomastoid muscle (PBSCM) was investigated and the ratio between the distance from the mastoid apex (MAA) to CNXI at the PBSCM and the distance from MAA to the posterior border where the PBSCM is attached to the clavicle increased as height of the subject increased (p<0.05).Conclusion: It must be kept in mind that it is better to search for CNXI in taller subjects more inferiorly at the posterior border of the sternocleidomastoid muscle

Selektif disventilasyon sendromu: Anatomik ve klinik özellikler

Objectives: This study aims to evaluate the clinical features of patients who underwent surgery for isolated attic cholesteatoma and were diagnosed with selective dysventilation syndrome (SDVS). Patients and Methods: Pre- and postoperative clinical data of 33 SDVS patients (20 males, 13 females; mean age 31.8 years; range, 17 to 56 years) operated on for isolated attic cholesteatoma between January 2016 and September 2017 were retrospectively examined and recorded. Mastoid development was evaluated from preoperative temporal bone computed tomography images. Pre- and postoperative first year pure tone audiometry test results were recorded. Based on intraoperative findings, patients were divided into three groups according to epitympanic diaphragm/attic aeration pattern. The data of these three groups were compared statistically. Results: There were 17 type A (tympanic istmus blockage+complete tensor fold), 10 type B (tympanic istmus blockage+attical vertical blockage+incomplete/complete tensor fold) and six type C (complete epidermization of the attic+complete tensor fold) patients. The most common complaint in all groups was otorrhea. In groups A and B, mild retraction was generally observed in the tympanic membrane, whereas advanced retraction was observed in group C (p=0.002). There was evident mastoid hypopneumatization in each group and mastoid development was significantly worse in group C (p=0.023). In addition, facial dehiscence and recurrence rates were significantly higher in group C (p=0.006, p=0.011, respectively). Conclusion: Selective dysventilation in the epitympanum may cause chronic middle ear diseases such as cholesteatoma behind mild retraction. The mastoid hypopneumatization caused by dysventilation is also undeniable in triggering this condition. During the surgery, particularly in isolated epitympanum pathologies, epitympanic diaphragm should be carefully evaluated.Amaç: Bu çalışmada izole attik kolesteatomu nedeniyle cerrahi geçirip selektif disventilasyon sendromu (SDVS) tanısı konulan hastaların klinik özellikleri değerlendirildi. Hastalar ve Yöntemler: Ocak 2016 - Eylül 2017 tarihleri arasında izole attik kolesteatomu nedeniyle ameliyat edilen 33 SDVS hastasının (20 erkek, 13 kadın; ort. yaş 31.8 yıl; dağılım, 17-56 yıl) ameliyat öncesi ve sonrası klinik verileri retrospektif olarak incelendi ve kaydedildi. Mastoid gelişim ameliyat öncesi temporal kemik bilgisayarlı tomografi görüntülerinden değerlendirildi. Ameliyat öncesi ve sonrası birinci yıl saf ses odyometri sonuçları kaydedildi. Ameliyat sırasında elde edilen bulgulara dayanılarak hastalar epitimpanik diyafram/attik havalanma paternine göre üç gruba ayrıldı. Bu üç grubun verileri istatistiksel olarak karşılaştırıldı. Bulgular: On yedi tip A (timpanik istmus blokajı+tam tensör fold), 10 tip B (timpanik istmus blokajı+attik dikey blokajı+tam olmayan/tam tensör fold) ve altı tip C (attik tam epidermizasyonu+tam tensor fold) hasta vardı. Tüm gruplarda en yaygın yakınma otore idi. Grup A ve B’de genellikle timpan membranda hafif retraksiyon gözlenirken grup C’de ileri düzey retraksiyon gözlenlendi (p=0.002). Her grupta belirgin mastoid hipopnömotizasyon vardı ve mastoid gelişim grup C’de anlamlı olarak daha kötüydü (p=0.023). Ayrıca, fasiyal dehissans ve nüks oranları grup C’de anlamlı olarak daha yüksekti (sırasıyla, p=0.006, p=0.011). Sonuç: Epitimpanumda selektif disventilasyon, hafif retraksiyon arkasında kolesteatom gibi kronik orta kulak hastalıklarına neden olabilir. Bu durumun tetiklenmesinde disventilasyonun neden olduğu mastoid hipopnömotizasyonun katkısı yadsınamaz. Cerrahi sırasında, özellikle izole epitimpanum patolojilerinde, epitimpanik diyafram dikkatle değerlendirilmelidi

Efficacy of topical isoconazole nitrate in the treatment of otomycosis

Purpose: Various agents with various antifungal properties are widely used for otomycosis eradication. However, there is still no consensus on the most effective agent. Therefore, the present study aims to investigate the efficacy of topical 1% isoconazole nitrate cream in the treatment of otomycosis. Methods: This prospective study included 43 patients who were applied to our outpatient clinic with complaints of ear pain, itching, aural fullness, and hypoacusis, and were diagnosed with unilateral otomycosis. After aspiration and cleaning, the external ear canal was filled with 1% isoconazole nitrate cream using an iv cannula and insulin syringe. Control examinations were performed on the 5th, 10th, 15th, and 20th days. In the follow-up examinations, patients were asked about how many days after the cream administration the pain and itching completely relief and the answers were recorded. Results: In the first control examination of 23 (92%) of 25 patients with pain, it was observed that the pain and otoendoscopic examination findings completely recovered. In the second control, it was found that both pain and otoendoscopic examination findings completely recovered in the remaining 2 patients (25 patients, 100%). 35 patients complained of itching and it was observed that itching and otoendoscopic examination findings completely recovered in 26 patients (75%) in the first control, 5 more patients (31 patients, 88.6%) in the second control, and 2 more patients (33 patients, 94.3%) in the third control examination. Conclusion: Isoconazole nitrate cream appears to be an effective and easily applicable agent for the treatment of otomycosis

Learning curve of septoplasty procedure

Objectives: The aim of this study was to investigate possible relationship between surgical experience and septoplasty-related data and to determine the learning curve based on surgery duration. Patients and Methods: The first 60 septoplasty patients of four Ear, Nose and Throat residents who completed an 18-month residency training in our clinic between August 2015 and December 2017 were included in the study. A total of 240 patients (155 males, 85 females; mean age 32.8±10.6 years; range, 17 to 60 years) were evaluated. The first 10 patients were grouped as Group A, 11-20 patients as Group B, 21-30 patients as Group C, 31-40 patients as Group D, 41-50 patients as Group E, and 51-60 patients as Group F. The patients’ files were retrospectively reviewed to obtain information on demographics, postoperative hospital stay, complications, revision operation requirements, and operation time. The mean operation time was calculated. Duration of surgery was used to evaluate the maturity of surgical skills. Results: The mean operation time was 60.0±17.3 min. The mean operation times of the patients in Group A and Group B were significantly longer than that of the patients in Group C, Group D, Group E, and Group F. There was no significant difference between the groups in terms of length of hospital stay, complications, and revision rates. Conclusion: As the surgeon's experience increases, the operation time decreases, and after 20 patients, it reaches the plateau level. Based on these data, it can be concluded that ENT residents should practice more than 20 patients to learn the septoplasty procedure sufficiently

Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss

Abstract Introduction Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss

Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss

<div><p>Abstract Introduction Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.</p></div