Volume 7 Issue 3 (2017)

Objective: The aim of this study was to evaluate the efficacy of hyperbaric oxygen (HBO) therapy as salvage therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of systemic therapy.

Methods: Forty-eight consecutive patients with refractory ISSNHL were enrolled retrospectively. All patients were given systemic steroid therapy by tapered doses. In addition, forty-one patients received intratympanic dexamethasone injection. Hearing outcomes were determined by recovery rate according to Siegel's criteria and hearing gains in pure-tone average (PTA) measured by audiometry before and after HBO therapy. The effects of prognostic factors on hearing recovery were also evaluated.

Results: Thirteen (27%) patients responded to HBO therapy. The remaining 35 (73%) patients did not show any improvement. After HBO therapy, significant improvement was found in mean hearing thresholds at all frequencies. Only the level of initial PTA level and gender were significantly associated with recovery. Patients with severe hearing loss (≥70 dB) had significantly better results.

Conclusion: Salvage HBO therapy may be beneficial in patients with ISSNHL who failed to recover by primary combined steroid therapy. Further hearing recovery with salvage HBO therapy can be expected, particularly in patients with PTA greater than 70 dB.

Objective: The aim of this study was to search the codon 200 polymorphism on the glutathione peroxidase 1 gene (GPX1) and A/T changes on the promoter region of the catalase gene (CAT) in cochlear implant patients with congenital profound hearing loss.

Methods: Sixty-five cochlear implant patients with congenital hearing loss and 100 age- and gender-matched healthy volunteers were evaluated between 2011 and 2013. Genomic DNA was extracted from peripheral blood samples by using the salting out procedure. The T/A polymorphism in the promoter region of the CAT gene (rs7943316) and GPX1 gene codon 200 proline to leucine substitution (rs1050450) were determined by polymerase chain reaction and restriction fragment length polymorphisms.

Results: No statistically significant difference was found in CC and CT genotypes in codon 200 on GPX1 (CC, p=0.10; CT, p=0.48) However, there was a statistically significant difference in the TT genotype (p=0.04). In the CAT promoter region, there was no statistically significant difference between the patients and control groups (AA, p=0.41; TA, p=0.16; TT, p=0.08).

Conclusion: As a conclusion, the TT genotype on the GPX1 codon 200 may have a relationship with congenital profound sensorineural hearing loss.

Objective: To investigate the effect of cochlear implantation on articulation by using voice- onset time (VOT).

Methods: At the first phase of this study, a total of 25 children without hearing loss were examined. VOT values of Turkish plosive consonants of /p/, /b/, /t/, /d/, /k/, /g/ specific to this age group were estimated, and their standardization was achieved. To this end, Kay Elemetrics CSL 4400 software (Key Elemetrics Ltd, Lincoln Park, NJ, USA) was used. Referencing these VOT values, 40 children ages ranging between 4 and 11 years who underwent cochlear implantation in our clinic were divided into six groups based on the duration of cochlear implantation, and VOT values were determined in these groups. These groups were compared within themselves, and with healthy children.

Results: VOT values of consonants increased as the duration of cochlear implantation increased and approached to those of the children with normal hearing, and at the end of four years of cochlear implant use, they caught up with those of the normal hearing group.

Conclusion: Our results have shown that early stage implantation, and use of implant for an adequate time period have a favorable impact on articulation in other words on comprehensibility of speech. We thought that VOT can be use in the evaluation of the effect of cochlear implant on the development of speech.

Objective: The aim of this study is to evaluate endoscopic and paranasal computed tomography (PNCT) findings in cases of failed dacryocystorhinostomy (DCR).

Methods: This study included 30 cases of failed DCR (18 females, 12 males; mean age: 49.9±18.9 years) and 30 successful DCR patients (20 females, 9 males; mean age: 56.3±15.9 years). The reasons for the recurrence of the disease were evaluated using preoperative endoscopic examination and PNCT findings.

Results: Endoscopic pathology was identified in 24 out of 30 failed cases (80%), while endoscopic pathology was identified in 12 out of 30 successful cases (40%) (p<0.05). PNCT revealed nasal pathology in 24 out of 30 failed cases (80%), and in 15 out of 30 successful cases (50%) (p<0.05).

Conclusion: Endonasal and sinonasal pathologies may be associated with DCR failure. Before the commencement of revision DCR, endoscopic examination and PNCT may provide valuable information regarding the underlying etiology.

Objective: To evaluate olfactory functions in patients with laryngopharyngeal reflux.

Methods: The study consisted of control and reflux groups. Each group consisted of 50 patients. Reflux group received the diagnosis of reflux based on reflux symptom index, and reflux symptom scores. The olfactory test of Connecticut Chemosensory Clinical Research Center (CCCRC) was conducted on these 2 groups, and the results were compared.

Results: No statistically significant difference was found between the demographic characteristics such as gender and smoking rates while there was statistically significant difference between the groups in terms of age variable. The covariance analysis was used to eliminate the effect of age variable. The mean scores calculated after covariance analysis were compared. It is known that the higher score of CCCRC test is 7 points. Accordingly, CCCRC scores of the control and reflux groups were 5.84± 0.13, and 5.20±0.11, respectively. This difference between two groups was statistically significant (p<0.001).

Conclusion: Laryngopharyngeal reflux disease has a negative effect on olfactory functions without total loss in olfactory functions.

Objective: To evaluate the beneficial effect of steroid therapy in the treatment of diabetic patients with Bell's palsy (BP).

Methods: There were three patient groups in the present retrospective study. Group I consisted of diabetic patients with BP who were hospitalized for corticosteroid treatment, whereas Group II was composed of diabetic patients with BP who refused to receive steroid therapy after being informed about the adverse effects of the regimen. Thirty age- and sex-matched non-diabetic BP patients treated with steroid therapy on an outpatient basis constituted Group III. House-Brackmann (H-B) grades at onset and 12 months after facial paralysis, mean complete recovery time and the number of patients who demonstrated satisfactory recovery were compared between the groups.

Results: There was no statistically significant difference with regard to H-B grades, mean recovery time or number of patients with satisfactory recovery at onset and 12 months after facial paralysis among the study groups.

Conclusion: In diabetic patients with BP, the recovery of facial functions may be satisfactory without steroid therapy as long as the regulation of blood sugar and blood pressure levels are ensured with regular medical follow-up.

Objective: To evaluate the histopathological findings in Reinke's edema and correlate them with otorhinolaryngologic symptoms other than dysphonia.

Methods: Patients diagnosed with Reinke's edema as the source of dysphonia from January to December 2016 were included in this retrospective study. The histopathological findings in Reinke's edema and the correlation with otorhinolaryngologic symptoms other than dysphonia were evaluated.

Results: A total of 13 patients (3 females, 10 males) with Reinke's edema all of whom were smokers underwent surgery. In all of the specimens, the main histopathological finding was edema in the lamina propria of the vocal folds. The dominant inflammatory cell type in the stroma was determined by evaluating the whole microscopic subepithelial zone. The cell types included plasma cells, lymphocytes, monocytes, and neutrophils.

Conclusion: In Reinke's edema the main pathologic finding is the collection of edematous fluid in Reinke's space. As our study was limited by the small number of cases, we could not find any statistically significant correlation between the inflammatory cell types and clinical characteristics of Reinke's edema.

Juvenile ossifying fibroma is an uncommon, benign, fibro-osseous neoplasm with aggressive local growth. This tumor is distinguished from other fibro-osseous lesions especially by its age of onset, aggressive behavior, and clinical presentation. Two microscopic types have been described: trabecular and psammomatoid variants. In this case report, we presented a young male patient with juvenile psammomatoid ossifying fibroma involving the sinonasal region, skull base and the orbit, which was treated with endoscopic surgery.

Objective: This study was conducted to investigate nasal nitric oxide (nNO) and its metabolites nasal nitrite-nitrate (nNOx) in patients with allergic rhinitis (AR), the effects of two different drugs (oral antihistamine and intranasal steroid) on nNOx and the presence of a correlation between nNOx and clinical parameters.

Methods: Sixty patients with active symptoms of perennial AR and 25 healthy adults as a control group were enrolled. The patients were randomized into two groups. Half of the patients received fexofenadine 1x120 mg/day orally, and the other half received triamcinolone acetonide 1x2 puff/day intranasally for one month. The amount of nNOx in nasal lavage fluid was measured by using a commercially available kit and the photometric endpoint determination method.

Results: Pre-treatment levels of NOx in the nasal lavage fluids (1.92± 1.20 mg/l) of patients with AR were found to be significantly higher when compared with nasal lavage fluid NOx levels of healthy adults (1.38±0.78 mg/l) (p=0.04). The post-treatment nNOx level (1.52±0.85 mg/l) was significantly lower when compared with the pre-treatment value (p=0.028).

Conclusion: Nasal nitric oxide metabolites were shown to be good biomarkers for AR, and that oral fexofenadine significantly decreased nNOx levels.