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

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

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

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

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

The prevalance of dysphonia among teachers and the relationship between the risk factors

Bu çalışmanın amacı, ses semptomlarının görülmesi açısından mesleksel risk grubu olan öğretmenlerde ses kalite bozukluğunun (disfoni) yaygınlığını tesbit etmek, risk faktörlerinden ses yükü ve fiziksel risk faktörlerinin disfoni ile arasındaki ilişkiyi belirlemek ve disfoniye neden olan larengeal lezyonları ortaya koymaktır. Yaptığımız literatür araştırmasında ülkemizde yapılan benzer bir çalışmaya rastlamadık. Çalışma, Nisan - Ekim 2006 tarihleri arasında Denizli'nin Milli Eğitim Müdürlüğü'ne bağlı, sosyoekonomik farklılık gösteren üç ayrı semtindeki üç ilköğretim okulu ve bunların anasınıf öğretmenleri ile beş ayrı anaokulundaki anasınıf öğretmenleri arasında yapılmıştır. Öğretmenlere ses semptomlarıyla ilgili anketler dağıtılmış ve bu anketler Pamukkale Üniversitesi Tıp Fakültesi Kulak Burun Boğaz kliniğinde incelenerek yaşları 22-56 arasında değişen 105 kadın ve 62 erkek öğretmen, ses semptomlarına göre iki grup halinde çalışmaya alınmıştır. Ses semptomu olan 87 öğretmene kliniğimizde teleskopik larenks muayenesi yapılarak muayene grubu oluşturulmuş ve ses semptomu olmayan 80 öğretmen de kontrol grubu olarak karşılaştırmaya alınmıştır. Anket sonuçlarına göre, her iki öğretmenden birinin (%52) mesleklerini icra ederken sesleriyle ilgili fiziksel rahatsızlık yaşadığı belirlenmiştir. Çalışmada, ses yükünü arttırdığı düşünülen risk faktörlerinden aktif çalışma saati ve öğretmenlerin sorumlu oldukları eğitim-öğretim kademesi değerlendirilmiş; fiziksel risk faktörlerinden de yaş, cinsiyet, öğretmenlerdeki işitme kaybı ve üst solunum yolu mukozasını etkilen alerjik hastalık varlığı, yakın zamanda geçirilmiş enfeksiyon varlığı, larengofarengeal reflü semptomları ve sigara kullanımı değerlendirmeye alınmıştır. 42 statistiksel veriler ses semptomlarının görülme riskinde larengofarengeal reflü varlığının 7.4 kat, alerjik hastalık varlığının da 4.7 kat artışa neden olduğunu gösterirken, sınıf öğretmenlerinin anasınıf öğretmenlerinden ve branş öğretmenlerinin de sınıf öğretmenlerinden daha fazla risk taşıdığını göstermiştir. Disfoniye sebep olduğu düşünülen risk faktörlerinden, yaş, cinsiyet, haftalık aktif çalışma saati, yakın zamanda bir üst solunum yolu enfeksiyonu geçirmiş olmak, öğretmenlerdeki işitme kaybı varlığı ve sigara kullanıcısı olmak bizim çalışmamızda istatistiksel olarak anlamlılık kazanmamıştır. Larenks muayenesi yapılan örneklerin 65'inde (%65.5) larenks muayenesi normalken, 23'ünde (%26.4) reflü larenjitine ait bulgular, 6'sında (%6.8) vokal kord nodülü ve 1'inde (%1.1) de vokal kord polibi tesbit edilmiştir. Larenks muayenesi normal olan ve şimdiki zamanda en az bir ses semptomu veren örnekler, fonksiyonel ses bozukluğu açısından değerlendirilmemiştir. Sonuç olarak çalışmamız, öğretmenlerdeki ses kalite bozukluğunun yaygın görülen fiziksel bir rahatsızlık olduğunu ve bu kişilerin değerlendirilirken larengofarengeal reflü ve alerjik hastalık varlığının öncelikle sorgulanması gerektiğini düşündürmektedir.The aim of this study is to detect the prevalance of dysphonia, to determine the relationship between dysphonia and the physical and vocal loading risk factors and to demonstrate the laryngeal pathologies that cause dysphonia among teachers who represent an occupational risk group for the development of voice symptoms. To the best of our knowledge, this is the first study that has been performed in our country concerning this subject. This study has been performed between April and October 2006. The teachers of three primary and five nursery schools assigned to national education directorate in three socioeconomically different districts of Denizli were enrolled in the study. Questionnaires about the voice symptoms were distributed among the teachers. These questionnaires were examined at Pamukkale University Faculty of Medicine department of otorhinolaryngology. One hundred five female and 62 male teachers aged between 22 and 56 were divided into two groups according to voice symptoms. Telescopic laryngeal examination was performed for the 87 teachers with voice symptoms. This examination group was compared with the control group of 80 teachers without voice symptoms. According to the results of this questionnaire, it was detected that one of every two teachers experienced physical disturbance concerning their voice during their profession. Among the risk factors that increase vocal loading, active working hours and the education grade that the teachers were responsible for were evaluated. The physical risk factors that were evaluated were age, gender, hearing loss of teachers and the factors that affect the mucosa of the upper respiratory tract which are allergic disorders, recent infection, symptoms of laryngopharyngeal reflux and cigarette smoking. 44 The statistical data demonstrated that, the risk of experiencing voice symptoms increased 7.4 times by the presence of laryngopharyngeal reflux and 4.7 times by the allergic disorders. The risk of primary school teachers for the development of voice symptoms was greater than the nursery school teachers and that of the secondary school teachers was greater than the primary school teachers. Among the risk factors that are thought to cause dysphonia gender, age, weekly working hours, recent upper respiratory tract infection, hearing loss and cigarette smoking were not found to be statistically significant. Among the cases to whom laryngeal examination was performed, 65 (65.5%) of them had normal laryngeal examination, 23 (26.4%) of them had signs of laryngeal reflux, 6 (6.8%) of them had vocal cord nodule and 1 (1.1%) of them had vocal cord polyp. The subjects with at least one voice symptom but with normal laryngeal examination were not evaluated in terms of functional dysphonia. This study showed that dysphonia is a common disorder among teachers and while evaluating these subjects the presence of laryngopharyngeal reflux and allergic disorders should primarily be considered

Evaluation of SCL-90R and it's short forms in patients with vertigo

Ankarali, Handan Camdeviren/0000-0002-3613-0523WOS: 000341271900004Objective: Psychiatric symptom screening tests for patients who suffer from imbalance and dizziness are generally used in majority of clinics. Symptom checklist-90 Revised (SCL-90R) is one of these tests. The aims of this study are to analyze the Turkish version of SCL-90R, compare to its short version and investigate whether if it is possible to create a short version or not. Material and Method: The sample of this study consisted of 2100 patients who admitted to tertiary care neurotology department for imbalance and dizziness. Three different SCL-90R versions as the original, Brief Symptom Inventory (BSI) and Brief Symptom checklist-18 (BSI-18) were retrospectively studied. These three tests were evaluated with regards to global severity index, totalpositive symptoms and positive symptom index. The correlation between results were compared by Pearson correlation test. Structural integrity studies were also conducted with using raw data of SCL-90R. Results: There were strong correlations among the three questionnaires. While the structural distribution of questions are consisted of 10 factors in the standard form (SCL-90), the short form (containing 49 questions) which was created from our results was found to have different structural distribution. Moreover the distribution of questions were quite different than the actual structure and the questions from different factors were grouped under different factors. The short form, which was created from our results, showed similar properties with the BSI. The internal consistency reliability test showed significance for 9 of them. Eventually, we created a short form consisting of 9 factors and 49 questions. In this state, it shows similar features with BSI and contains a similar number of questions. Conclusion: Due to the difference in structural analysis, the results obtained by the sub-scales of the questionnaires should be evaluated very carefully. We think the short form we created can be used easily since the general values resulted from it are comparable to the the original questionnaire

Yenidoǧanda işitme tarama programi ve yönetimi

Congenital hearing loss (CHL) is one of the most common neurologic birth defect in the world. Over the years, developments in technique and instrumentation have significantly and positively altered the direction, accuracy, and success of neonatal hearing screening program. In this program, Otoacoustic emission (OAE) testing and/or automated auditory brainstem response (ABR) testing is used; however, there are very important differences between the two tests. While OAE testing reflects the status of the peripheral auditory system extending to the cochlear outer hair cells, ABR testing reflects the status of the peripheral auditory system, the eighth nerve, and the brainstem auditory pathway. Current universal neonatal hearing screening statistics indicate an overall hearing loss rate of 1-3/1000 live birth and 1-6/100% in the neonatal intensive care units. CHL rate is also 2.2/1000 live births in our country. An undiagnosed or delayed diagnosed hearing impairment may have serious effect on a child's language, social, emotional, cognitive, academic, and vocational development, significantly affecting the child's quality of life. Assessment of hearing loss in children is very important because early identification and appropriate intervention of hearing loss results in better development and educational outcomes. For this reason, all newborns should be screened by appropriate screening program (OAE and/or ABR) within first month of life. Those who do not pass screening should have a comprehensive audiological evaluation at no later than three months of age, and infants with confirmed hearing loss should receive appropriate intervention at no later than six months of age. Copyright © 2017 by Türkiye Klinikleri

The subscales and short forms of the dizziness handicap inventory: are they useful for comparison of the patient groups?

Purpose: Dizziness Handicap Inventory (DHI) is one of the most frequently used surveys for vertigo. The aim of the study was re-analyze the consistency of subscales and correlation between original and different short forms. Method: The data of 2111 patients were analyzed. Original three subscales, screening form of DHI and short form of DHI were evaluated. The suitability of the data set for factor analysis and factor structure was analyzed with Kaiser–Meyer–Olkin (KMO) coefficient, Bartlett’s Sphericity Test, and Varimax method. Pearson correlation analysis was performed. Results: Factor analysis showed that two factor solutions are more prominent in our data. The factors proposed in different studies are not in harmony with each other. There is high correlation between the original and screening and short forms of DHI. Conclusions: This study indicated that the factor structure of the scale was not consistent. It is not advised to use subscale scores for comparison especially in international level. Therefore, total score should be used rather than the scores of the subscales. Using DHI screening form instead of original 25 questions is more convenient, because it is highly correlated with the original one and has fewer questions.Implications for rehabilitation Factor structure of the DHI is not consistent enough for comparison of the international studies. Total score of DHI is reliable. Using the screening version of DHI is better, because it is highly correlated with the original form and has fewer questions (10 questions). © 2016 Informa UK Limited, trading as Taylor & Francis Group