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Objective: To determine the general characteristics of 42 patients who were operated for juvenile nasopharyngeal angiofibroma (JNA); and to determine the important aspects and the advantages of endoscopic transnasal approach over other techniques. Methods: Forty-two patients with JNA, 12 of whom were operated with endoscopic transnasal approach at a tertiary care center between March 1987 and February 2008 were evaluated retrospectively. The general characteristics of the patients, presenting signs and symptoms, the surgical approach performed, tumor stage, whether preoperative embolization was performed and rates of recurrence were studied. Patients who underwent surgery with endoscopic transnasal approach were compared to others who underwent surgery with different techniques. Results: One patient was female and the remaining 41 patients were male. Twelve patients underwent endoscopic removal of the tumor. Lateral rhinotomy was used for 10 patients, degloving approach for 7 patients, transpalatal approach for 6 patients, combined approach for another 6 patients and finally midfacial splitting for 1 patient. Seventeen percent of the patients had referred with recurrent diseases. According to staging system of Radkowski, about half of the patients belonged to stage IIA or IIC. The mean age was 16 and the most common presenting symptom was nasal obstruction. Preoperative embolization rate was 59.5% while recurrence rate in the postoperative period was 17%. In non-endoscopic approaches, the tumor contiguity and operative plan were determined via radiological data. In operations performed with endoscopic transnasal approach in patients with JNA, the radiological data as well as a detailed endoscopic tumor examination were utilized and it was observed that tumor invaded the middle turbinate in 67% and both the septum and middle turbinate in 42% of the patients. While preoperative embolization was performed only in larger tumors before 1998, it was recruited in all subjects after 1998. Preoperative and

Background: The aim of this study is to investigate nasal and paranasal signs and symptoms of the primary Sjögren's syndrome patients and compare them with healthy controls. Methodology: Seventy-seven (7 M, 70 F) primary Sjögren's syndome patients and 77 healthy controls were included in the study. Anterior rhinoscopy, nasal endoscopy, 5 component smell discrimination test, nasal clearance analysis with saccharin test and electrorhinomanometer were performed. Results: Nasal crusting was present in 31 and 24 individuals in patient and control groups, respectively. Sinusitis was present in 2 and 1 individuals in patient and control groups, respectively. Nasal polyposis was present in 7 and 1 individuals in patient and control groups, respectively. These differences were not statistically different. Conclusion: Although there were some findings in a few patients, nasal findings were insignificant and mild even in patients with severe oral or ocular findings. Rhinomanometry, nasal clearance determination or smell discrimination tests have very little value in the diagnosis or management of primary Sjögren's syndrome. Nasal polyposis was higher in the patient group, though it did not reach a significant level. Nasal glandular involvement is mild and insignificant in primary Sjögren's syndrome.

Objective: To assess the effect of inner ear pressure on middle ear impedance in patients with large vestibular aqueduct syndrome (LVAS). Methods: Data from admittance tympanometry and multifrequency tympanometry on 8 LVAS patients and control subjects were studied. Results: Static acoustic compliance (SAC) values for the ears with stable sensorineural hearing loss (SNHL) were within the limits of the mean values of control groups except for two ears. The resonance frequency (RF) values of the ears with stable SNHL were lower than the mean values of control groups except for three ears. SAC values for the two ears with fluctuating SNHL were lower and the RF values were higher than the mean values of control groups. Conclusion: Decreased SAC values and increased RF values found in the ears with fluctuating SNHL might be an indirect indicator of increased inner ear pressure, while low RF values in the ears with stable SNHL might reflect the decreased inner ear impedance. #

The aim of this study was to investigate the eVect of high-dose betahistine treatment added to vestibular rehabilitation (VR) on the disability, balance and postural stability in patients with unilateral vestibular disorder. The VR group (group 1, n = 24) and the VR + betahistine group (group 2, n = 23) were analyzed retrospectively. All patients were evaluated before and after an 8-week customized VR in terms of disability (Dizziness Handicap Inventory, DHI), dynamic balance [Dynamic Gait Index (DGI)] and postural stability (static posturography). In group 1 and group 2, diVerences between DHI, DGI and falling index score on static posturography before and after the exercise program were signiWcant (p < 0.05). In addition, a signiWcant diVerence was detected only in group 2 in the variables evaluated in static posturography-Fourier 4 analysis (p < 0.05). Both VR and betahistine + VR have a positive eVect on disability and balance in patients with unilateral vestibular disorder. Betahistine treatment added to VR was eVective in increasing postural stability.

The aim of this study was to assess the efficacy and safety of single and low-dose intratympanic gentamicin therapy in patients with Ménière disease and who were monitored both with caloric tests and vestibular-evoked myogenic potentials (VEMPs) to see if VEMPs have an additional role in predicting the efficacy of the drug. Study design: This is a prospective cohort study. Setting: Tertiary referral center is the study setting. Patients: Twenty-five intractable Ménière disease patients were included as the study group. Intervention(s): Low-dose (16 mg/mL), single-shot intratympanic gentamicin was applied. VEMP and caloric test were applied 2 weeks after the application. Main outcome measure(s): Safety and efficacy of protocol were evaluated at the sixth month postoperatively with tonal audiogram and visual analog scale, respectively. Results: Mean average pure-tone hearing threshold at 0.5, 1, 2, 4, and 8 kHz was 49.6 and 51.0 dB before and after the application, respectively (P N .05). Mean pretreatment and posttreatment visual analog scale scores of patients were 17.6 mm (10-30 mm) and 74.6 mm (41-100 mm), respectively (P b .01). Posttreatment VEMPs were absent in 17, deteriorated in 2, and not changed in 6 patients. VEMP was a significant predictor of posttreatment visual analog scale score, whereas caloric test was not (P b .01). Conclusions: Low-dose, single-shot intratympanic gentamicin treatment proved to be effective and safe among intractable Ménière patients. VEMPs obtained at posttreatment second week were significant predictors of patients posttreatment sixth-month dizziness status and vertigo control.

Short-term effects of vestibular rehabilitation in patients with chronic unilateral vestibular dysfunction: a randomized controlled study. Arch Phys Med Rehabil 20092009;90:1325-31. Objective: To evaluate the short-term effects of vestibular rehabilitation on symptom, disability, balance, and postural stability in patients with chronic unilateral vestibular dysfunction. Design: Randomized controlled trial.

The aim of this study is to evaluate the internal consistency, test-retest reliability, construct validity, and sensitivity to change of the Activities-specific Balance Confidence Scale (ABC) in people with peripheral vestibular disorder. Thirty-three patients with unilateral peripheral vestibular disease were included in the study. Patients were also evaluated with the Visual Analog Scale, the Romberg test (eyes open, closed), the tandem Romberg test (eyes open, closed), standing on foam (eyes open, closed), static posturography, Five Times Sit to Stand test, Timed Up to Go test, gait speed, Dynamic Gait Index, Functional Gait Assessment, and Dizziness Handicap Inventory. To assess sensitivity to change, 27 patients were involved in a 4-week customized vestibular rehabilitation program and then reassessed at the end of 4 weeks. The individual item intraclass correlation coefficient ranged from 0.67 to 0.92 and Crohnbach a ranged from 0.67 to 0.93. The Crohnbach a value for whole scale was determined as 0.95. Although the Dizziness Handicap Inventory showed significant correlation with the Turkish ABC Scale (r = 0.51-0.54, P < 0.05), no such a correlation was observed between the Turkish ABC Scale and the other parameters assessed (P > 0.05). Both Turkish ABC Scale and the other parameters assessed showed significant improvement after 4-week customized exercise program (P < 0.05). The Turkish ABC Scale is a culturally relevant, reliable, and sensitive to change tool for measuring self-perceived balance confidence in unilateral peripheral vestibular disease.

Laryngopharyngeal reflux (LPR), which is defined as the backflow of gastric contents into the upper aerodigestive tract, is a relatively common disorder. However, its diagnosis still poses many problems. Twenty-four-hour double-probe pH monitoring is currently the diagnostic test of choice, but it has many disadvantages. Thus, an empiric trial of antireflux therapy has been suggested as an alternative method for diagnosis. The purpose of this article is to evaluate the validity of this alternative method in the management of LPR. The study group consisted of 36 patients with symptoms and physical findings suggesting LPR. The control subjects were 23 healthy adults. Twenty-four-hour double-probe pH monitoring was performed both in the study group and the control group, and the results were compared. In addition, the symptoms and physical findings in the study group was scored by the modified reflux symptom index (MRSI) and reflux finding score (RFS) at four intervals: before the star...

Lemierre's syndrome is a rare but fatal thrombophlebitis of the internal jugular vein (IJV). It usually follows acute oropharyngeal infections in healthy, young adults. Fusobacterium necrophorum is the most common bacteria that causes Lemierre's syndrome, whereas various microorganisms are reported. We are reporting a case with Lemierre's syndrome secondary to otitis media, which is a rare occurrence of a rare disease.

The aim of this study was to evaluate the effect of laparoscopic antireflux surgery (LARS) on the laryngeal symptoms, physical findings and voice parameters of gastroesophageal reflux disease (GERD) patients with or without laryngopharyngeal reflux (LPR). Forty-one GERD patients predominantly with LPR symptoms (Group I) and twenty-six GERD patients without LPR symptoms (Group II) who had LARS were prospectively analysed before and 2 years after the surgery. Upper gastrointestinal endoscopy, 24-h ambulatory pH or MII-pH monitoring was performed in all cases. A reflux study group including specialists from five departments in a university hospital decided surgical indications. Patients were asked to fill out a validated LPR and voice quality questionnaire (Reflux Symptom Index and Voice Handicap Index-10). Laryngeal findings were evaluated and scored using a laryngoscopic grading scale [Reflux Finding Score (RFS)], by four blinded ENT specialists. GRBAS scale was done by a blinded oto...

To establish a questionnaire and check its validity and reliability for the diagnosis of vestibular migraine in patients reporting recurrent vestibular symptoms. Vestibular migraine is the most common cause for recurrent spontaneous vertigo. However, it is still underdiagnosed needing validated and reliable screening instruments such as ID Migraine, that can be used in primary care settings, dizziness, and migraine clinics. Sixty consecutive patients referred to our dizziness clinic with recurring vestibular symptoms were given a questionnaire that they filled in, consisting of 8 short and simple questions. The questionnaire-based diagnosis was compared with the diagnosis based on face-to-face interview and clinical examination. Test stability was evaluated by asking the patients to fill in the questionnaire a week later during a second visit. κ analysis was used to assess item-specific test-retest reliability and also the conformity between the questionnaire-based diagnosis and the...

Background: The exposure of the round window (RW) through the facial recess (FR) is sometimes partial. The anatomic variations that alter RW exposure during cochleostomy have not been clearly defined to date. Aims: The aim of this study was to assess the best FR position in which to achieve the widest exposure of the RW niche and to define the topographic relationship between two other important anatomical structures, the facial nerve (FN) and the chorda tympani (CT). Study Design: Cadaver study. Methods: Twenty-four temporal bones were included in the study. Anterior and posterior epitympanectomy and posterior tympanotomy were performed after mastoidectomy. Bone was removed until the FN and CT were skeletonized and the CT branching point was visible. Two pictures were taken. The first was taken when the facial recess was at its widest exposure, while the second was taken when the RW niche was maximally exposed through the facial recess. Various measurements were taken. Results: The RW niche was totally visible in 19 temporal bones (79.2%). The RW was partially visible in the remaining five bones (20.8%). The unexposed part of the RW lay posteromedial to the FN in these five bones. While the branching point of the CT could be visualized in all cases at the widest exposure of RW, the part of the FN distal to the branching point was hidden in eight subjects (33.3%) under the posterior wall of the external ear canal. Conclusions: The RW niche was totally visible in most of the temporal bones. The RW lay posteromedial to the FN in some cases and total exposure was impossible.

Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoustic energy generated during the osteotomies is transferred to the cochlea via temporomandibular joint and air conduction. The aim of this study was to assess the effect of mandibulectomy and mandibulotomy on cochlear function. This study was carried out on 15 patients who underwent at an otolaryngology department of a tertiary medical center between January 2013 and August 2015. The study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of the surgery, type of surgery, preoperative pure-tone audiometry, preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. Of the DPOAE measurements, there was a statistically significant difference between the signal-to-noise ratio measurement on the right ear measurement at 4 kHz (P <0.05). Additionally, there was a statistically significant correlation between the signal-to-noise ratio measurements and the side of the osteotomy (P <0.05). In conclusion, it is found that mandibulectomy and mandibulotomy procedure has a negative effect on cochlear function in the early period. The DPOAEs were diminished on the osteotomy site in day one postoperatively. Results with a longer follow-up time can yield more information on the prognosis of the cochlear damage.

INTRODUCTION: Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. METHODS: Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. An emergency specialist and a neurologist performed HIT. vHIT was conducted by an neuro-otology research fellow. RESULTS: Forty patients 26 male, 14 female with a mean age of 49 years were included in the analyses. Final diagnoses were VN in 24 and PCS in 16 patients. In the VN group, clinical HIT was assessed as abnormal in 19(80%) cases by the emergency specialist and in 20(83%) by the neurologist. In all PCS patients, HIT was recorded as normal both by the emergency specialist and the neurologist (100%). On vHIT, patients with VN had significantly low gain values for both the ipsilesional and contralesional sides when compared with the healthy controls, with significantly lower figures for the ipsilesional side (p < 0.001). All patients in this group had normal DWI-MRI. PCS patients had bilaterally low gain (p < 0.05) on vHIT. However, gain asymmetry was not significant. Subgroup analyses according to presence of brainstem involvement revealed bilateral low gain (p < 0.05) in patients with brainstem infarction (anterior inferior cerebellar artery-posterior inferior cerebellar artery stroke, AICA-PICA stroke) whereas patients with pure cerebellar infarction (posterior inferior cerebellar artery-superior cerebellar artery stroke, PICA-SCA stroke) had gain values similar to healthy controls. With a gain cutoff ≤0.75 and gain asymmetry cutoff ≥17%, as determined by ROC analysis, 100% of PCS patients and 80% of VN patients were correctly diagnosed. CONCLUSIONS: Clinical HIT, either performed by an emergency specialist or neurologist is equivalent to vHIT gain and gain asymmetry analysis as conducted by neuro-otologist in the diagnosis of PCS, albeit mislabeling about 20% of VN 1 These authors share the first authorship.

The aim of this study was to compare the audiologic outcomes of the patients who underwent endoscopy on one ear and microscopic tympanoplasty on the other, and to investigate the operative time, graft success, postoperative pain and health status. This prospective randomized controlled study was carried out in Ege University ENT Department between February 2015 and September 2016. The patients who had bilateral chronic otitis media, normal middle ear mucosa and a hearing loss difference of 10 dB or less between the two ears randomly underwent microscopic tympanoplasty in one ear and endoscopic tympanoplasty in the contralateral ear, with 6-month intervals. 13 patients were included in the study with a mean age of 36.17 ± 3.61 years (range 17-53 years, 7 female, 6 male). The improvement in air-bone gap for groups 1 (endoscopic) and 2 (microscopic) was 9.48 ± 5.23 and 9.89 ± 2.79 dB, respectively. The duration of the surgery in group 1 was significantly lower than that in group 2 (p \ 0.01). VAS scores were 2.15 ± 0.37 and 3.76 ± 1.64 cm for groups 1 and 2, respectively (p = 0.006). The endoscopic approach for type 1 tympanoplasty offers shorter surgery time, better health status and lower postoperative pain than microscopic surgery. In addition, endoscopic surgery offers comparable improvement in air-bone gap and similar graft success. The endoscopic approach has comparable audiological and morphological graft outcomes with the microscopic one. The endoscopic approach yielded better health and pain status for the same patients. Level of evidence This is an individual randomized controlled trial. The level of evidence is 1b.