Volume 2 Issue 3 (2012)

Objective: To present new information to the literature by imaging the calcospherule forming tympanosclerotic plaque's structure with atomic force microscope and to analyze the elementary structure of it with energy dispersive X-ray detector adapted to the scanning electron microscope.

Methods: Samples taken from 30 patients who underwent surgery for tympanosclerosis were retrospectively evaluated in our tertiary referral center. The surface topography and three-dimensional images of the hardest plaque was analyzed using atomic force microscopy and examined elemental composition of 5 different calcospherule in 5 different plaques using scanning electron microscopy energy dispersive X-ray spectroscopy.

Results: In all sides of study, the rate of fronto-ethmoidal cell was 20.9%. When cases with sinonasal signs (group II and III) and control group (group I) were compared, intersiThree-dimensional analysis of the tympanosclerotic plaque using atomic force microscopy showed calcium phosphate crystalline structures. Scanning electron microscopy with energy dispersive X-ray spectroscopy was used to quantify the calcium, phosphate, carbon, nitrogen, oxygen, sodium, and magnesium present.

Conclusion: We believe that knowledge of the surface topography and elemental composition of tympanosclerotic plaque will contribute to understanding the etiology of tympanosclerosis and its treatment.

Objective: To develop an experimental acute suppurative otitis media model and compare the responses of rats to penicillin and combinations of leukotriene antagonist with respect to histopathological observations conducted at both early and late phases.

Methods: A total of eighty-three ears from fifty six Wistar rats used in this study. Pneumococcus suspension was injected transtympanically to all the rats. Subjects were classified under four different groups having 14 rats at each. In Group A, intramuscular penicillin G was injected to rats for a period of five days. In Group B, intraperitoneal montelukast was injected for 21 days in addition to penicillin. In Group C, intraperitoneal montelukast and in Group D intraperitoneal isotonic NaCl was injected to rats for 21 days. Cross-sections were semi-quantitatively graded with respect to various inflammatory components.

Results: No significant difference was found between the groups, apart from mucosal vascularization with respect to mucosal and tympanic membrane (TM) parameters at early phases. However, statistically significant differences were found for the improvement of TM thickness with the help of penicillin treatment. Furthermore, considerable deviations were observed for the recuperation of TM and mucosal inflammation for groups where subjects were injected with montekulast as compared to other groups of the study.

Conclusion: The results of this study clearly show that the beneficial effects of the antibiotic (penicillin) as well as leukotriene antagonist (montelukast) is statistically different those of placebo in acute otitis media in rats. When the parameters of inflammation in the rat middle ear were compared with each other, most of these parameters did not show any statistically different beneficial effects in montelukast and penicillin groups.

Objective: Effective premedication is one of the key factors for anesthetic management of autistic children. We designed a study protocol to compare two different dose regimens of midazolam plus ketamine for premedication of autistic children.

Methods: We performed a prospective randomized double-blind study in 142 autistic children, aged 1-17 years, undergoing brain SPECT imaging procedure. Group I received oral 0.5 mg/kg midazolam with 3 mg/kg ketamine and Group II received oral midazolam 0.25 mg/kg with ketamine 6 mg/kg. Onset of sedation and sedation score just before the induction of anesthesia were recorded. Anxiety of children was assessed by a four point scale at admittance, during separation from parents and at venipuncture. Post-anesthetic recovery was assessed using the modified Aldrete score. Postoperative vomiting and any other side effects were recorded when seen. Ten days after the procedure, parents were interviewed for changes in behaviors, sleep disturbances and feeding difficulties.

Results: Acceptable sedation scores were obtained in both groups. Success rates for parental separation and intravenous cannulation were higher than 85% in both groups. There were no differences between two groups in terms of sedation onset time, intravenous cannulation anxiety score, parental separation anxiety score, side effects and changes in behaviors, sleep disturbances and feeding difficulties. The only significant difference between two groups is sedation scores before induction of anesthesia. Children in high ketamine group had deeper sedation state than those in the other group.

Conclusion: Our results showed that both dose regimens provided successful premedication in autistic children.

Objective: Laryngopharyngeal reflux (LPR), an atypical form of gastroesophageal reflux (GER), may present with non-specific symptoms of upper aerodigestive system. In this study, we aimed to show the LPR frequency of various symptom groups by 24-hour double-channel pH monitorization.

Methods: A total of 125 patients and 20 healthy controls were enrolled to this study between July 2007 and July 2008. Patients were assigned to 5 different groups with respect to their chief complaints (gastrointestinal, bronchial, laryngeal, pharyngeal and rhinologic). All patients underwent 24-hour double-channel pH monitorization and diagnosis of LPR was confirmed if one or more pH results were below 4.0 in proximal channel.

Results: Laryngopharyngeal reflux was detected in 18 of 19 patients (94%) in gastrointestinal group, 24 of 25 patients (96%) in bronchial group, 26 of 31 patients (83%) in laryngeal group, 27 of 29 patients (93%) in pharyngeal group, 19 of 21 patients (90%) in rhinologic group and 2 of 20 patients (10%) in the control group. The highest incidence of LPR was encountered in the bronchial group, whereas the lowest incidence for LPR was detected in laryngeal group.

Conclusion: Laryngopharyngeal reflux may present with a wide spectrum of symptoms in daily otorhinolaryngology practice. With respect to our results, 24-hour double-channel pH monitorization turns out to be a reliable method in the diagnosis of LPR in cases suspected for laryngopharyngeal reflux.

Objective: We aimed to compare the efficacy of temporalis muscle fascia and tragal cartilage island grafts after tympanoplasty in terms of functional hearing outcomes and tympanometric findings.

Methods: A total of 42 patients were enrolled in this study and Group 1 including 14 patients was defined as fascia group while Group 2 including 28 patients was defined as tragal cartilage group. After preoperative odiometric and typmpanometric measurements were done, grefts were laid as under-overlay with the same surgical technique. Only patients with intact grafts at the end 6th month of observation period were included in the study. Surgical outcomes were compared with respect to preoperative and postoperative 6th month odiometric and tympanometric findings within and between the two groups.

Results: Postoperative pure tone audiometric results were significantly better than preoperative values in both groups (p=0.001 for fascia graft; p0.05) at pure tone audiometric and tympanometric results between fascia and cartialge groups regarding the pre and postoperative tests.

Conclusion: Tragal cartilage island graft provides satisfactory outcomes in tympanoplasty in terms of both functional hearing results and resistance against retraction and resorption. However, it must be kept in mind that constriction of middle ear volume after use of tragal cartilage grafts in tympanoplasty is not uncommon.

Angiofibromas typically arise from the nasopharynx in young adolescent males. Extranasopharyngeal angiofibroma (ENA) implicates the vascular fibrous nodules occurring outside the nasopharynx. Since the clinical characteristics of ENA differ from those of nasopharyngeal angiofibroma, diagnosis can be challenging. Biopsy is usually discouraged due to the risk of bleeding. A high index of suspicion and a methodical evaluation are essential in establishing the proper diagnosis and treatment. We report the rare case of a 49-year-old woman who presented with headache and epistaxis. The mass was found to arise from right sphenoid sinus and total excision could be accomplished with endoscopic sinus surgery. Postoperative histopathologic analysis was consistent with an angiofibroma. To the best of our knowledge, only 3 cases of ENA arising from the sphenoid sinus have been previously reported in the English-language literature.

The conventional treatment modalities are surgery and/or radiation therapy in patients with early stage squamous cell carcinoma of the supraglottic larynx. In the literature, there are different opinions about the success of chemotherapy regimens with curative or inductive intent in patients with early stage laryngeal carcinoma. In this case report, a patient with T2N0M0 squamous cell carcinoma of the supraglottic larynx who presented with local recurrence and regional metastasis after a 54 months of non-followed period which follows two courses of cisplatinum/5-FU induction chemotherapy alone was presented. The beneficial effects of the induction chemotherapy in patients with early stage laryngeal carcinoma are doubtful. However, this regimen may be useful to estimate the possible success of radiotherapy by counseling with the patients who initially refused the conservative partial laryngectomy and with their families.