Tonsillotomy versus Tonsillectomy for Chronic Recurrent Tonsillitis in Children

Objective: This study was conducted to compare two different surgical methods; partial tonsil resection using the bipolar technique, tonsillotomy (TT), and total tonsillectomy (TE) (blunt dissection) for recurrent tonsillitis in children. The frequency of recurrent throat infections was determined during postoperative follow-up.Methods: A total of 393 patients were included in this study. TT was performed on 174 patients (100 males, 74 females) and TE on 219 patients (112 males, 107 females). Following surgery, an analysis was made of treatment outcomes of patients with upper respiratory tract infections. The patients were followed up for 12-48 months. Their parents were also contacted by telephone to determine the frequency of reinfection and their satisfaction with the surgery. Also, parents of the patients completed a questionnaire pertaining to postoperative satisfaction (scale of 1-10).Results: In the TT group, 14 (8.1%) patients had recurrent tonsillitis postoperatively. In the TE group, 12 (5.4%) patients required antibiotherapy due to recurrent pharyngitis after the surgery. There was no significant difference between the two groups in terms of the one-year infection recurrence rate after surgery (p=0.281). Three patients (1.6%) in the TT group and 12 (5.4%) in the TE group complained of bleeding within the first 24 hours. The rate of bleeding was significantly lower in the TT group than the TE group (p=0.001). There were no fatalities in either group.Conclusion: In both groups, the rate of reinfection accorded with the requirement for postoperative antibiotics. For recurrent tonsillitis, TT was as effective as TE. However, TT was superior in terms of the risk of bleeding

Why Do We Not Need CT in Patients Who Undergo Type I Tympanoplasty?

Objective:High-resolution computed tomography (HRCT) has gained wide acceptance in diagnostic work-up of suppurative chronic otitis media. Most ear surgeons order HRCT to make a rational operative plan, especially in the presence of symptoms, such as refractory otorrhea with bad odor, epithelial debris at retraction pockets, and defects in bony walls of the middle ear. The aim of this study was to show the lack of necessity of preoperative HRCT by evaluating its predictive value in patients who underwent type I tympanoplasty.Methods:The study included a patient group who underwent tympanoplasty with dry perforation and normal middle ear mucosa. The intraoperative findings of 43 patients were compared with preoperative HRCT and audiogram findings.Results:There was no significance between preoperative air conduction threshold and existence of ossicular erosion in HRCT. HRCT incorrectly predicted the presence of cholesteatoma in two patients. The positive predictive value of HRCT in detecting soft or granulation tissue was 4/14 (28.57%). The sensitivity and specificity of HRCT in the diagnosis of ossicular chain status were 9.09% and 90.62%, respectively.Conclusion:HRCT plays an important role in the assessment of patients with suppurative chronic otitis media and cholesteatoma. However, preoperative HRCT in patients who have undergone type I tympanoplasty is not necessary. It has no benefit and also leads patients to unnecessary radiation exposure

Evaluation of benign paroxysmal positional vertigo variants with video electronystagmography

Benign paroksismal pozisyonel vertigo (BPPV), periferik vertigonun en sık periferik nedenidir. BPPV, hızlı bir baş pozisyonu değişikliği ile oluşan karakteristik paroksismal pozisyonel nistagmus ile birlikte geçici vertigo olarak tanımlanabilir. Posterior kanal benign paroksismal pozisyonel vertigo en sık görülen BPPV formudur. Bu çalışmamızın amacı BPPV varyantlarının kliğimizde kullanılan videoelektronistagmografi (VENG) eşliğinde tanısının konulması ve tedavisinin yapılmasıdır. BPPV'lu hastaların VENG sonuçları incelenmiştir. VENG ile elde edilen elektrofizyolojik bulguların ne sıklıkta görüldüğü ve hangi BPPV varyantlarında nasıl bulgular verdiği incelenmiştir. Aynı zamanda en sık görülen posterior semisirküler kanal BPPV'sunun tedavisinde uygulanan modifiye Epley manevrası ile Brandt-Daroff ev egzersizinin tedavideki etkinliği değerlendirilmiştir. Uludağ Üniversitesi Tıp Fakültesi Hastanesi KBB Anabilim Dalı'na Mart 2012-Mayıs 2014 tarihleri arasında baş dönmesi yakınmasıyla başvuran ve dinamik pozisyonel testler ile BPPV tanısı konulan, 27-76 yaşları arasında toplam 63 hasta ile yapılan bu prospektif çalışmada hastaların epidemiyolojik verileri ile videoelektronistagmografi (VENG) bulguları ve tedavi sonuçları kaydedildi. 50 hasta posterior kanal, 8 hastada lateral kanal ve 2 hastada anterior kanal tutulumu, 2 hastada bilateral posterior kanal ve 1 hastada santral pozisyonel vertigo mevcuttu. Posterior kanal BPPV hastaları randomize olarak iki gruba bölündü. İlk gruba (25 hasta) tedavi olarak modifiye Epley manevrası uygulandı. İkinci gruba (25 hasta) tedavi olarak Brandt-Daroff egzersizi uygulandı. Hastalar haftalık takibe alındı. İyileşme süreleri kaydedildi. Modifiye Epley manevrası uygulanan grupta bu oranlar birinci haftada %76, ikinci haftada %96 ve üçüncü haftada %100 idi. Brandt Daroff ev egzersizi uygulanan grupta birinci, ikinci ve üçüncü manevradan sonraki iyilesme oranları sırasıyla %64, %88 ve %100 idi. Kalan 13 hasta üçüncü grup olarak değerlendirildi. VENG kaydında aşağı atımlı nistagmus tespit edilen iki hasta anterior kanal BPPV olarak değerlendirildi. 8 hastada horizontal kanal BPPV bulundu. Geotropik nistagmus tespit edilen 5 hastada horizontal kanal kanalolitiazisi düşünüldü. Hastalar Barbekü manevrası ile tedavi edildi. Ageotropik nistagmus tespit edilen 3 hastada horizontal kanal kupulolitiaizisi düşünüldü. Hastalara tedavi olarak modifiye Semont manevrası yapıldı. Tüm hastalara VENG eşiliğinde tanı konuldu. VENG ile yapılan göz hareketlerinin kaydı bize tanı ve tedavide oldukça yarar sağlamaktadır. Brandt-Daroff egzersizi ve Modifiye Epley manevralarının her ikisinin de BPPV tedavisinde oldukca etkili yöntemler olduğu görüldü. Klinik bulguları ve iyileşme zamanları karşılaştırıldığında iki grup arasında, istatistiksel olarak anlamlı farklılık saptanmadı.Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study is to establish a diagnosis of BPPV variants by videoelectronystagmography (VENG) that is used in our clinic and their treatment to be done. VENG results of patients who have BPPV were examined. On the prevalence of electrophysiological findings obtained by VENG and how findings have given for which BPPV variants were examined. At the same time the effectiveness of Brandt-Daroff home exercises in the treatment with modified Epley maneuver implemented in treatment of most common posterior semicircular canal BPPV. A total of 63 patients between 27 and 76 years old who were referred to the Department of Otorhinolaryngology of Uludağ University Faculty of Medicine Hospital between March 2012 and May 2014 complaining of positional vertigo who were diagnosed as BPPV with the dynamic positional tests were enrolled in a prospective study patients, epidemiological data and results from the videoelectronystagmography (VENG), were recorded. 50 patients had involvement of the posterior canal, 8 of the horizontal canal, and 2 of the anterior canal, 2 of the bilateral posterior canal and one of the santral positional vertigo. Posterior canal BPPV patients were randomly divided into two groups. The first group (25 patients) was treated as the modified particle repositioning maneuver. Brandt-Daroff exercises as the second group ( 25 patients) underwent treatment. Patients were followed weekly. Cure weeks were recorded. The ratios for Modified Epley maneuver applied group were 76%, 96% and 100% respectively. The recovery ratios for Brandt-Daroff applied group after first, second and third maneuvers were 64%, 88% and 100% respectively. The remaining 13 patients were evaluated as the third group. VENG record two patients anterior semicircular canal BPPV with positional downbeat nystagmus. Horizontal canal BPPV were found in 8 patients. Geotropic nystagmus in 5 patients who were considered semicircular canal canalithiasis. Patients were treated with barbecue maneuver. Ageotropic nystagmus in 3 patients who were considered semisircular canal cupulolithiasis. Patients were treated with modified maneuver Semont. All patients were diagnosed guided VENG. VENG control is helpful for the diagnosis and for the registration of the eye movements during the therapeutic manoeuvres. It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers are very effective maneuvers in the treatment of BPPV. Clinical findings and cure time compared between the two groups, statistically significant differences were not detected