Volume 9 Issue 3 (2019)

The author reports on a case of relapsing polychondritis in which partial insertion of a cochlear implant has been successful. A woman with known relapsing polychondritis gave a history of increasingly severe auditory loss of sensorineural type occurring bilaterally. Previous repeated treatments with corticosteroids and immunosuppressive medications had been attempted. A right-sided cochlear implantation with partial electrode array insertion was carried out due to the patient’s cochlea being obliterated. The outcome was excellent and the improvement in hearing was maintained. Relapsing polychondritis (RP) is a rarely-seen disorder, the aetiology of which is obscure, but which results in inflammation within cartilage throughout the entire body. The cochlea may become obliterated by this process. Cochlear implantation may be needed in such circumstances. The successful outcome in this case shows a potential role for cochlear implantation in individuals with inner ear disorders produced by immune disorders or relapsing polychondritis.

Objective: The aim of this study is to investigate the association between subjective and objective masculine vocal quality in hormone-naïve trans-male individuals.

Methods: Twenty-seven hormone-naïve trans-male individuals were recruited for the study. All the study participants had applied to undergo the gender transition process and been referred to the Voice Clinic. The Self-Perception of Voice Masculinity (SPVM) scale and the mean fundamental frequency (F0) were used to assess any association between subjective and objective vocal masculinity.

Results: The mean age of study participants was 25.3 years. The median F0 lay within the normal limits for cisgender females. However, in 12 out of 27 cases, F0 lay within the gender-ambiguous frequency range. SPVM scores were higher in this ambiguous group, a result with a strong tendency toward statistical significance (p=0.053). A moderate negative correlation between SPVM and F0 scores was observed (r=-0.484, p=0.027). The smoking frequency was high, with 77.8% of individuals in the group as a whole being smokers. Not only were F0 values of smokers lower than those of non-smokers, but their SPVM scores were also higher.

Conclusion: The findings from this study indicate that diversity in objective and subjective voice parameters exists even within the hormone naïve period. There appear to be several factors which influence F0 to a significant extent. Accordingly, a more comprehensive approach is called for when assessing transgender voice at all stages of the gender-affirming medical treatment process. The high frequency of smoking amongst the trans-male population should also be noted as it constitutes a serious health hazard.

Objective: The aim of this study is to evaluate any possible effects of chronic otitis media (COM), with or without accompanying cholesteatoma, on bone conduction thresholds (BCT).

Methods: A total of 112 cases who underwent surgery for unilateral COM between 2006 and 2014 were enrolled in the study. Eighty cases had no cholesteatoma (Group 1). Thirty-two cases did have cholesteatoma (Group 2). Prior to surgery, the temporal bone was evaluated radiologically by use of high resolution computed tomography. The presence of a clinically and radiologically normal contralateral ear was the principal selection criterion for the cases. BCT at 0.5, 1, 2, 4 kHz and their averages were evaluated with pure tone audiogram (PTA) and the normal and diseased ears in each group were compared. This comparison was also made between the diseased ears in Groups 1 and 2.

Results: There was a statistically significant difference observed between the mean BCT scores obtained by PTA for the normal/diseased ears in Group 1 (9.78±0.98/17.34±1.71 dB) and in Group 2 (9.10±0.99/17.58±2.59 dB). This statistically significant difference was observed for each of the four different frequencies (p0.05).

Conclusion: As a result of this study, we can say that COM may lead to sensorineural hearing loss. However, we observed that the presence of cholesteatoma does not exert an additional negative effect on cochlear function.

Objective: The aim is to share our experience of the clinical features and important issues encountered in diagnosing and treating multiple head and neck schwannoma cases seen at our centre, all of which went on to have surgical treatment.

Methods: This was a retrospective review of the medical records of cases over an 11-year period (2007–2018) diagnosed with schwannoma by post-surgical histopathology. The demographic characteristics of these cases, along with their clinical characteristics, namely, tumour location, preoperative diagnostic tests undertaken, surgical approach used, and any postoperative complications, including the management of such complications, were reviewed.

Results: A total of 31 patients (18 male, and 13 female) were included in the study. Contrast-enhanced magnetic resonance imaging was the most commonly used pre-operative diagnostic method (77%). 58% of the cases were extra- and 42% intra-cranial. Extracranial schwannomas were noted to arise from several different areas of the head and neck region. The most common neurological deficit post-operatively was facial paralysis.

Conclusion: Since head and neck schwannomas can develop from any area where the nerve sheath is present, they may present with a wide variety of non-specific symptoms. The treatment plan should be made with the anticipated preoperative and postoperative neurological deficit firmly in mind.

Objective: Rhinoplasty is done to improve the morphology of the nose whilst also restoring its physiological function. Currently it is possible to perform rhinoplasty and endoscopic sinus surgery simultaneously. The need has therefore arisen to evaluate anatomical variation within the nose and paranasal sinuses in symptom-free patients who are scheduled for rhinoplasty. Coronal computed tomography (CT) is the standard method used to evaluate the nose and paranasal sinuses. We aimed to evaluate the frequency of anatomical variation noted within the nose and paranasal sinuses on coronal CT in patients scheduled for rhinoplasty.

Methods: This is a descriptive, cross-sectional, retrospective study of CT findings in 84 patients who underwent rhinoplasty at Mostafa Khomeini Hospital, Shahed University, Tehran between 2011-13. The CT findings were evaluated in three different predefined categories: nasal septal, nasal turbinate, and paranasal sinuses abnormalities.

Results: The study involved 84 individuals, consisting of 26 men and 58 women. The most frequent findings in the nasal septum category were nasal septal deviation (69.04%) and nasal septal spur (33.33%), whereas concha bullosa (45.23%) and inferior turbinate hypertrophy were the most frequent abnormality in the nasal turbinates category. Mucosal thickening of the sinuses (45.23%) and partial opacification of the sinuses (21.42%) were the most common findings in the paranasal sinuses.

Conclusion: The high frequency of anatomical variation, inflammatory and congenital abnormal findings in CT images of the paranasal sinuses in patients scheduled for rhinoplasty indicates that preoperative CT examination may be useful in avoiding multiple surgical operations and in reducing costs.

Objective: To evaluate the benefits of a contralateral hearing aid on expressive and receptive language development and auditory perception performance over a 36-month post-surgical period in children implanted on a single side with a cochlear device for bilateral pre-lingual profound sensorineural hearing loss.

Methods: Seventy-five patients with idiopathic profound sensorineural hearing loss were included. The cases were divided into two groups: cochlear implant users (50 patients, “CI group”) and cochlear implant plus hearing aid users (25 patients, “CI+HA group”). Language development and auditory performance were compared in the two groups during the first 3 years following cochlear implant surgery. The Pre-school Language Scale-4 was used to assess language development and the LittlEars® Auditory Survey, Meaningful Auditory Integration Scale and Meaningful Use of Speech Scale were employed to assess auditory perception performance.

Results: Language development in the CI+HA group was superior to that in the CI group at 6 months post-surgery, in terms of receptive and expressive language development; auditory perception performance was also superior in the CI+HA group, compared to the CI group.

Conclusion: The use of a contralateral hearing aid in cochlear implanted children with prelingual sensorineural hearing loss positively contributes to language devel-opment and auditory perception performance.

Objective: Childhood onset speech fluency disorder (stuttering) is a communication disorder beginning in childhood, and is characterised by interruption to speech flow, sound prolongations and pauses produced by repetition of a particular sound or word. The aim of this study was to investigate the sociodemographic characteristics, comorbid psychiatric diagnoses and other variables that are associated with stuttering.

Methods: Sixty-four children and adolescents aged under 18 years and attending the child and adolescent psychiatry or otorhinolaryngology (ENT) outpatient clinic between November 2017 and June 2019 were enrolled in the study. ENT examination was carried out. A sociodemographic questionnaire was also administered to the participants. The psychiatric evaluation of the patients was performed according to DSM-5 criteria.

Results: The mean age was 7.36±3.76 years. 70.3% of the cases were male. The mean age at onset of stuttering was 4.85±2.34 years and the average stuttering duration was 2.31 years. In 31.3% of cases a life stressor had preceded stuttering, 21.9% had a positive family history, and 40.6% had comorbid psychiatric morbidity. The most common comorbid psychiatric diagnoses were specific learning disorder, speech sound disorder and attention deficit hyperactivity disorder.

Conclusion: According to the results obtained, stuttering was 2.3 times more common in males, and 68.7% of all cases were below the age of 5 years. The most common psychiatric diagnoses found in cases of stuttering are within the neurodevelopmental disorders grouping. Since psychiatric diagnoses occur at such a high frequency, it is important to address this comorbidity when treating stuttering

Objective: Whilst orbital complications arising from acute rhinosinusitis are infrequent in contemporary practice, the spread of infection orbitally or intracranially can result in severe complications and a high mortality. This study aims to review cases of orbital complications arising from rhinosinusitis in the light of the published literature on the topic.

Methods: Eight cases of individuals presenting to a particular clinic with the development of orbital complications following sinusitis within the previous four years were included in the study. The characteristic features of these cases in terms of diagnosis, treatment and follow-up were investigated.

Results: The mean age of all cases was 29.5 years. In three cases, orbital abscess, and in five cases, preseptal cellulitis, were observed as complications. Both surgical and medical treatment was administered in three cases, while medical treatment alone was used for five cases.

Conclusion: The region where the complications of rhinosinusitis are most commonly observed is the orbit, due to its proximity to the paranasal sinuses, especially the ethmoid cells. Where limitation of eye movements, proptosis, and a decrease in vision exists alongside an orbital abscess which itself has developed as a complication of sinusitis, surgical treatment is the most important option to consider to prevent complications.

Objective: This study aimed to evaluate balance disorders and potential risk factors for falling in patients with hypothyroidism, as well as postural stability and the risk of falling.

Methods: The participants’ sex, age, body mass index (BMI), falls history in the past one year, and Falls Efficacy Scale - International (FES-I), Neuropathic Pain Diagnostic questionnaire (DN4) and clinical symptoms were recorded. The stability index (SI), weight distribution index (WDI) and falls risk analysis were performed for postural stability by objective computerised dynamic posturography.

Results: 50 patients were matched for age and sex (mean age:41.7±11 years; age range:19-61 years) with 47 healthy (euthyroid) controls (mean age:39±9.6 years; age range:23-60 years). All SI, HL-WDI and falls risk scores, except FES-I, DN4 and NO-SI, were significantly higher in the patient group. In addition, other symptoms were present at a higher rate, with the exception of morning stiffness (p0.05). However, there was a slight positive correlation between the existence of paraesthetic symptoms, a history of falling, and the overall SI and HLWDI values (r>0.3 and p<0.05).

Conclusions: It was determined that, as postural stability is affected in cases of hypothyroidism, balance becomes disordered and the risk of falls increases. This increase in the risk of falls was associated with being hypothyroid, but not with FT4 or TSH levels or the other factors evaluated.

Objective: This study aims to compare endoscopic and microscopic tympanoplasty in terms of graft success rate and hearing gain.

Methods: Medical records of 236 patients (99 females and 137 males) aged 18 to 74 years with chronic otitis media who underwent myringoplasty, between January 2014 and June 2017 were retrospectively compared. Patients were divided into two groups; microscopic myringoplasty (140 patients), endoscopic myringoplasty (96 patients). Demographic data, pure tone audiometric results preoperatively and 6 months postoperatively, operation time, hearing gain and graft success rate were evaluated.

Results: The mean operation time was 57.8±9.6 minutes for the endoscopic group and 78.6±17.7 minutes for the microscopic group (p<0.001). The mean preoperative airbone gap (ABG) was 24.1±11.5 dB for the microscopic group and 22.7±9.2 dB for the endoscopic group, whereas the mean postoperative ABG was 11.6±9.9 and 9.8±9.3 dB respectively. Graft success rate was 90.3% (213 patients) for entire group, 89.7% (131 patients) for the microscopic group, and 91.1% (82 patients) for the endoscopic group (p=0.727). The functional success rate (ABG≤10 dB) was 72.5% (171 patients) in the entire group. The mean hearing gain was 12.4±10.8 and 12.8±9 dB in the microscopic and endoscopic groups respectively.

Conclusion: Endoscopic technique offers similar graft success and hearing outcomes to microscopic technique along with a shorter operation time.