Volume 11 Issue 2 (2021)

Background: Different techniques are available for ossicular reconstruction in isolated incus defects. Our objective was to compare hearing reconstruction techniques in Austin–Kartush Group A (incus defect, intact manubrium mallei and mobile stapes are present) ossicular defects.

Methods: Patients with isolated incus long process defect whose hearing impairment was reconstructed and followed-up for 12 months were reviewed. The hearing outcomes of bone-cement manubrio-stapedioplasty, bone-cement incudostapedopexy, and partial ossicular replacement prosthesis techniques were compared.

Results: In the study, 49 ears of patients aged between 10 and 53 years (median 30) who underwent ossiculoplasty between June 2017 and July 2018 were included. All groups had statistically significant improvement in both air-conduction thresholds (ACT) and closure of the air-bone gap (ABG). There was no deterioration in bone-conduction thresholds (BCT) in any frequency. When the success rates of the groups were compared, there was no statistical difference.

Conclusion: In patients with a defective incus, intact manubrium mallei, and mobile stapes, high success rates could be achieved with appropriate and careful surgery using all 3 hearing reconstruction methods.

Objective: The current study aimed to analyze the occurrence of sensorineural hearing loss (SNHL) among diabetes mellitus (DM) patients and to correlate the degree of hearing loss with the duration and type of DM.

Methods: This was a hospital-based retrospective observational study, using data collected from 7382 hearing-impaired patients from January 1, 2016 to July 30, 2020. The data collected were blood glucose levels and hearing thresholds through pure-tone audiometry (PTA). The association between SNHL type/severity and the types of diabetes mellitus (DM) were measured.

Results: Diabetic SNHL was observed in 2786 (37.74%) of the patients. Of the 2786 patients with diabetes, 315 (11.3%) had type 1 DM and 2471 (88.7%) had type 2 DM. According to the PTA readings, SNHL was recorded in 2786 DM patients (37.74%) and 4596 non-diabetic patients (62.25%) (P < .001). The mean duration of DM was significantly high in the diabetic patients with SNHL [11.7 ± 7.6 years] than in those without SNHL [7.3 ± 5.4 years] (P = .001). The mean fasting blood glucose was higher in the diabetic patients with SNHL than in those without SNHL [175.3 ± 83.3mg/dL vs. 157.7 ± 54.9 mg/dL] (P = .247). A lower age at DM onset (P = .042) and a longer duration of diabetes were related to a higher severity of SNHL (P = .007). The age at onset and the duration of diabetes were associated with SNHL.

Conclusion: The study reveals high prevalence of SNHL in type 2 DM. Diabetes mellitus acts as a more significant initiating and progression factor of hearing loss than other factors. By using PTA, the early detection of hearing loss in type 2 DM may help to avoid the deafness or its further progression.

Background: The effect of ear drainage and middle ear inflammation due to chronic otitis media (COM) on infrared tympanic temperature measurement (ITTM) has not been demonstrated so far. This study aimed to reveal these effects.

Methods: Sixty patients with one perforated ear and one contralateral intact ear were included. These patients were divided into 2 groups. Group 1 included 30 patients with draining ears and inflamed middle ear mucosa, and group 2 included 30 patients with no drainage for the last 3 months and with normal middle ear mucosa. Tympanic temperature measurements were done for all ears in both groups. The data obtained from both groups were compared between and within groups.

Results: Mean perforated ear temperature and mean intact ear temperature were 36.95 ± 0.67°C and 36.74 ± 0.67°C, respectively, in group 1. This difference was statistically significant. In group 2, no statistically significant difference was found between the mean perforated ear temperature (36.87 ± 0.51°C) and the mean intact ear temperature (36.84 ± 0.51°C). A comparison of the perforated ears and the intact ears between the groups revealed no significant difference.

Conclusion: Although ear drainage and middle ear inflammation due to COM may lead a slight elevation in tympanic temperature, this elevation is not clinically significant. Neither wet perforation nor dry tympanic membrane perforations affect tympanic temperature. ITTM may still be a reliable method for temperature measurement in patients with COM.

Objective: Steroid therapy is the gold standard in treating sudden sensorineural hearing loss (SSNHL). This study aimed to compare the results of the systemic and intratympanic administration of steroids used to treat patients with SSNHL.

Methods: A retrospective analysis was performed with 90 patients treated for SSNHL in our clinic between 2014 and 2017. Intratympanic steroid (ITS) was administered to 44 patients and systemic administration (intravenous or oral) to 46. Pure-tone average (PTA) values were recorded before treatment and at the first and third months post-treatment. Hearing improvement was evaluated according to the Furahashi criteria.

Results: The pre-treatment PTA values were 68.9 ± 25.9 dB in the systemic steroidtreated group and 79.0 ± 22.6 dB in the intratympanic steroid-treated group, with no statistically significant difference determined (P = .07). After 1 month of treatment, the PTA median value was 6.0 (from −23.0 to −65.0) dB in the systemic group; and the median was 7.5 dB (from −13.0 to −84.0) in the intratympanic group. No statistically significant difference was determined between the groups in terms of regression in pure-tone median values after treatment (P = .90). According to the Furahashi criteria, in the evaluations between the 2 groups, those with complete improvement and significant improvement were compared together, and those with mild improvement and those without improvement were compared separately. There was no statistically significant difference in the distribution with respect to healing, between the groups (P = .692).

Conclusion: Although steroids––which are the only treatment with proven efficacy in sudden idiopathic hearing loss––are effective in the improvement of hearing, the methods of administration showed no differences in terms of effectiveness.

Objective: To investigate the changes in nasal airway patency with different head positions in patients with allergic rhinitis (AR).

Methods: A total of 30 patients diagnosed with AR were included. The patients were asked to stand upright (temperature, 22-24°C; humidity, 40-70%), to lie down at an angle of 45° from the horizontal position, and to lie down in a supine position, maintaining each position for 20 minutes. A four-phase rhinomanometric (4PR) evaluation was performed on them in these 3 body positions. The effective and vertex resistances during inspiration and expiration were evaluated utilizing HRR2 4PR (RhinoLab GmbH, Hamburg, Germany).

Results: There was a significant decrease in nasal resistance and an obvious increase in nasal conductance with the alteration from the supine to the 45° inclined position (P < .05). There were noteworthy differences in the 4PR scores between the standing and supine positions and the supine and 45° inclined positions (P < .05). In contrast, no remarkable differences were detected in the 4PR scores between the standing and 45° inclined positions (P > .05).

Conclusion: Our results showed that head elevation impacts nasal resistance and airflow conductance in patients with AR. Objective measures of nasal obstruction are more evident in the supine position than in the standing and 45° inclined positions. These findings might enable some practical recommendations which our patients can follow to relieve their nasal obstruction caused by AR.

Objective: The aim of this study was to investigate the isolated effect of moderateto- severe, lower, middle, and upper nasal septum deviation (NSD) and NSD angle on maxillary sinus volume (MSV).

Methods: The retrospective study included 94 NSD patients (mean age, 27.95 ± 12.01 years). NSD diagnosis and the measurements of NSD angle and MSV were performed using paranasal sinus computed tomography (PNS CT). The NSD angle was divided into 2 groups as moderate (≤9 to <15) and severe (≥15) according to its degree on PNS CT. Each group was divided into 3 subgroups as lower, middle, and upper NSD based on the localization of NSD. MSV was measured both on the affected and unaffected sides using volume-measuring software.

Results: Mean MSV was 13.76 ± 4.81 mL on the affected side as opposed to 14.46 ± 4.95 mL on the unaffected side in 94 patients (P = .03). The increase in the NSD angle had a significant effect on both MSVs (P = .037, for severe NSD). No significant difference was found between the side with lower, middle, or upper NSD and the contralateral side in terms of MSV (P > .05).

Conclusion: We consider that NSD and an angular increase in NSD may play a role in MSV, while NSDs in different locations do not affect MSVs.

Objective: The aim of our study was to compare the tissue damage in pediatric tonsillectomy operations performed with Erbe unipolar electrocautery (EUE) and the thermal welding system (TWS).

Methods: This prospective study included patients who had tonsillectomy for recurrent tonsillitis. In the study, 23 patients had tonsillectomy with EUE and 20 had tonsillectomy with TWS. The Faces Pain Scale (FPS) was used for pain assessment on the 1st, 5th, and 10th days postoperatively. On postoperative 5th and 10th days, the healing process in the operation sites was evaluated according to fibrin coverage of tonsil beds, with the Visual Analog Scale (VAS). The removed tonsil specimens were evaluated by a single blinded pathologist, to determine deepest necrosis depths and thermal effect under a light microscope (Olympus BX41).

Results: In the study 23 patients who had tonsillectomy with EUE and 20 patients who had tonsillectomy with TWS were included. There was statistically significant difference in the pain scores between the first and fifth days, and in the morphologic intensity of the thermal effect, in favor of the TWS group (P < .05). The VAS scores of the healing process in the postoperative 5th and 10th days were slightly better in the TWS group, but the difference was not statistically significant (P > .05). Also, there was no statistically significant difference found between the 2 techniques regarding the deepest necrosis depths (P > .05).

Conclusions: In our study, tonsillectomy with TWS was found to cause less tissue damage in the surrounding tissue and less pain in the early postoperative period, than EUE.

Aim: Type 2 diabetes mellitus (T2DM) is one of the most common comorbidities in patients diagnosed with obstructive sleep apnea syndrome (OSAS). The Hemoglobin Glycation Index (HGI) has been introduced as a new index of glycation, instead of HbA1c. We aimed to evaluate the relationship between the disease severity and HGI in non-diabetic patients diagnosed with OSAS, in comparison to diabetic patients.

Methods: Our study included 117 patients with OSAS, of whom 66 were non-diabetic while 51 patients had T2DM.

Results: A difference was observed between the groups in terms of age (P = .002), HGI (0.347 ± 0.25 vs. 1.380 ± 1.7; P < .0001), predicted HbA1c (P < .0001), HbA1c (P < .0001), fasting blood glucose (P < .0001), eosinophil count (P = .003), and total supine time (P = .044). The intragroup evaluation of groups 1 and 2 showed no significant relationship between HGI and the severity of OSAS, both in the diabetic and the non-diabetic groups (P > .05). The correlation analysis in the DM group showed HGI to be negatively correlated with predicted HbA1c, fasting blood glucose, Hgb, and RBC, but positively correlated with HbA1c, non-REM stage 3, and supine deep sleep time. In the non-DM group, a positive correlation of HGI was found with BMI, HbA1c, total apnea, central apnea, obstructive apnea, total mixed apnea counts, apnea index, total supine sleep time, and supine deep sleep time. However, a negative correlation was found with the non-REM stage 1 (P < .05 for all).

Conclusion: HGI is a new glycation index that shows no significant relationship with the severity of the disease or increased AHI, both in the non-diabetic and diabetic OSAS patients.

Background: Noise and light sensitivities are typical symptoms for migraine attack type headaches. Sometimes, these sensitivities can be observed without these attacks as well. The purpose of this study was to analyze sensitivity to noise in migraine patients.

Method: In the study, 30 patients with no hearing loss who were being followed-up for their migraine illness, and 30 patients with similar demographic characteristics who did not have migraine, were included. The patients were given a hearing test and their hearing thresholds were determined. All of the patients were administered the Weinstein Noise Sensitivity Scale. The demographic data and noise sensitivity levels of the 2 groups were compared.

Result: The mean score on the Weinstein Noise Sensitivity Scale was observed as 89.47 ± 14.66 in the group without migraine, and as 93.34 ± 12.61 in the group with migraine. Although there was no statistically significant difference between the mean scale scores of 2 groups, the mean result of migraine group was found higher in migraine group. When 2 groups were compared with respect to the noise sensitivity subgroup, which has 99 and higher scores, the migraine group was found to be statistically different from control group.

Conclusion: It was observed in this study that migraine patients experience noise sensitivity even without acute attacks. It is considered that preliminary information can be obtained about how the auditory and sensory pathways are affected in migraine patients, by using scales, similar to the noise sensitivity scale.

Objective: To investigate the effects of surgical treatment on blood parameters in patients with parathyroid adenoma.

Methods: Patients with a diagnosis of parathyroid adenoma, who underwent surgery between November 2011 and April 2016, were investigated retrospectively. These patients were evaluated according to white blood cell, lymphocyte, neutrophil, and platelet counts, hematocrit, mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and calcium and parathormone (PTH) levels before and after the surgery.

Results: The study included 103 patients. The number of male patients was 22 (21.4%), and the number of female patients was 81 (78.6%). The age of the patients ranged between 7 and 87, and the mean age was 54.7 ± 14.3. Preoperative and postoperative changes in lymphocyte, platelet, hematocrit, MPV, calcium and PTH levels were found to be statistically significant in our study, but the changes in NLR and PLR were not.

Conclusion: Hyperparathyroidism is a reason for chronic inflammation and may affect blood inflammation parameters. However, the correlation between NLR, PLR, and serum PTH levels was not statistically significant. This can be explained by the fact that surgery causes a significant change in the number of both platelets and lymphocytes. We found a positive correlation between lymphocyte, neutrophil, and platelet counts, hematocrit, MPV, and serum PTH levels.

Objective: The accuracy of biopsy technique and pathological reports from supraclavicular lymphadenopathy (ScLAP) biopsies in adults were evaluated.

Methods: Five hundred sixty-four lymph node excisions or aspiration biopsies because of lymphadenopathy from all cervical regions were retrospectively assessed. Demographic and clinical data collected included gender, age, preoperative diagnosis, biopsy or cytology type, location of ScLAP, and biopsy diagnosis.

Results: After exclusions for a variety of clinical and diagnostic reasons, the final analysis included 156 patients, of whom 34 (21.8%) underwent fine-needle aspiration (FNA), 69 (44.2%) core needle biopsy (CNB), and 53 (34%) excisional biopsies. In this study, 52 (33.3%) benign and 93 (59.6%) malignant diagnoses were reported. Totally, 11 of the 34 (32.3%) FNAs were insufficient for diagnosis. The size of the ScLAP (<10, 11-20, 21-30, >30 mm) did not affect malignancy risk. Patients aged > 55 years had a significantly greater likelihood of malignancy than younger patients. Logistic regression analysis showed that malignancy risk assessed by odds ratio (OR) was increased by male gender (P = .004; OR = 1.428; 95% CI 1.106-1.842), left side (P = .003; OR = 1.502; 95% CI 1.125-2.005) and age > 55 years (P = .007; OR = 2.631; 95%CI 1.275-5.431).

Conclusion: Regardless of size, biopsy or cytology should be performed in all appropriate masses. Although the size of the lymph node had no effect on malignancy risk, male gender, older age, and left side were associated with a significant increase in the likelihood of malignancy.

Objective: This study was aimed at analyzing the validity and reliability of a Turkish shortened version of Speech, Spatial and Qualities of Hearing (SSQ) scale for adults using hearing aids and/or cochlear implants. The analysis was based on three forms of the SSQ, namely, SSQ12-A, SSQ12-B, and SSQ12-C.

Methods: A total of two hundred and fifty-eight individuals with moderate or moderate- to-severe (n = 98), severe or very severe hearing loss (n = 71) and normal hearing (n = 89) from four centers participated in our study. SSQ12-A was administered to individuals who were suffering from hearing loss, and with normal hearing but were not previously fitted with a hearing aid. SSQ12-B was distributed to individuals who had been using a hearing aid for at least 6 months, and SSQ12-C was administered to individuals who had been using cochlear implants for at least 6 months. SSQ12-A was then re-administered to 27 individuals with hearing loss for the reliability of the questionnaire.

Results: The internal consistency and reliability of all the three questionnaires were high (Cronbach’s α = 0.96, α = 0.96, and α = 0.84, respectively). Individuals with moderate hearing loss derived higher scores than did the individuals with severe or very severe hearing in SSQ12-A and SSQ12-B. No statistically significant difference was found between the scores (p > 0.05) of the respondents in the first and second rounds of SSQ12-A administration.

Conclusions: The Turkish shortened version of the SSQ is a valid and reliable questionnaire for assessing hearing function. The three forms of the SSQ12 are useful for evaluatinghearing impairment and in organizing rehabilitation programs.