E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 30 (4)
Volume: 30  Issue: 4 - 2020
1.Cover

Pages I - III

ORIGINAL ARTICLE
2.The effect of body mass index on traditional 226 Hz tympanometry and wideband tympanometry test results
Şeyma Tuğba Öztürk, Eda Külekçi, Kübra Abacı, Mustafa Bülent Şerbetçioğlu
doi: 10.5606/Tr-ENT.2020.69885  Pages 113 - 117
INTRODUCTION: The aim of this study was to investigate the possible effects of body mass index (BMI) on traditional 226 Hz tympanometry and wideband tympanometry (WBT) to gain a better understanding of resonance frequency.
METHODS: A total of 158 ears of 79 volunteers (19 males, 60 females; mean age: 20.5 years; range, 18 to 27 years) who had normal hearing and normal otoscopic examination findings were included in the study between October 2019 and June 2020. By measuring the weight and height of the participants, their BMI values were classified into three groups: ≤18.5 kg/m2 (underweight), 18.5 to 24.9 kg/m2 (normal weight), and ≥25.0 kg/m2 (overweight). Tympanometric evaluations were conducted using the Interacoustics-Titan WBT.
RESULTS: The difference of ear canal volume (ECV) was significant between the two sexes (p<0.05), while there was no significant difference in the tympanometric peak pressure, compliance, gradient, and resonance frequency between the sexes (p>0.05). A significant difference was found in the ECV and resonance frequency among the three BMI groups (p<0.05). Accordingly, as the BMI increased, the ECV increased and the resonance frequency decreased (p<0.05).
DISCUSSION AND CONCLUSION: The BMI may affect ECV and resonance frequency values which should be considered during the examination.

3.The effect of vitamin D levels on prognosis of patients with facial paralysis
Ayşe Enise Göker, Semih Karaketir, Maide Hacer Alagöz, Ayca Başkadem Yılmazer, Hüseyin Sarı, Hasan Sami Bircan, Nilgün Başaran
doi: 10.5606/Tr-ENT.2020.88942  Pages 118 - 122
INTRODUCTION: This study aims to investigate the serum 25-hydroxyvitamin D3 [25(OH)D3] levels of patients with Bell’s palsy (BP), and to evaluate their role in prognosis and their impact on the disease etiology.
METHODS: A total of 49 patients (30 males, 19 females; mean age: 42.2±13.6 years; range, 19 to 67 years) who were diagnosed with BP and treated at our clinic between October 2019 and April 2020 were included. Blood samples were collected within 24 h after the onset of BP symptoms, and a standard oral pharmacological treatment was administered with prednisolone 1 mg/kg for 10 days and acyclovir 700 mg/day for six days. All patients were graded according to the House-Brackmann scale (HBS). The patients were divided into three groups as Grade 2, Grade 3, Grade ≥4. The patients with BP were further divided into two groups as healed (n=36) and not-healed ones (n=13). The vitamin D levels of the groups were compared.
RESULTS: Eleven (22%) patients were in the Grade 2 group, 21 (43%) patients were in the Grade 3 group, and 17 (35%) patients were in the Grade ≥4 group. A significant decrease in vitamin D levels was observed in the patients with HBS Grade ≥4, compared to Grade 3 and Grade 2 groups (p=0.002 and p<0.001, respectively). Vitamin D levels were significantly higher among the patients without sequelae than those with sequelae (p<0.001).
DISCUSSION AND CONCLUSION: Our study results indicate that vitamin D deficiency can affect prognosis of BP patients.

4.Intratumoral microhemorrhage detection on susceptibility-weighted imaging can help in preoperative differentiation of cerebellopontine angle vestibular schwannomas from meningiomas: Correlation with pathology findings
Ahmet Mesrur Halefoğlu, Canan Tanık
doi: 10.5606/Tr-ENT.2020.63644  Pages 123 - 130
INTRODUCTION: In this study, we aimed to evaluate whether intratumoral microhemorrhage detection on susceptibility-weighted imaging (SWI) could help in preoperative differentiation of cerebellopontine angle (CPA) vestibular schwannomas (VSs) from meningiomas.
METHODS: A total of 75 patients (32 males, 43 females; mean age: 45.5±16.7 years; range, 17 to 68 years) consisting of 61 VSs and 14 meningiomas located in the CPA cistern were retrospectively analyzed. All patients underwent contrast-enhanced magnetic resonance imaging (MRI) using the SWI sequence. All images in our study were obtained with a 12-channel phased-array head coil on a 1.5-Tesla clinical scanner. The presence of intratumoral microhemorrhages on SWI sequence was evaluated by demonstrating blooming artifacts as punctate hypointense regions. Both magnitude and phase-contrast images were used to verify microhemorrhages. All patients in our patient cohort underwent surgery and resected tumor specimens were evaluated by pathology.
RESULTS: All VS cases in our cohort exhibited multiple hypointense small foci causing blooming artifact on magnitude and processed SWI images. In the meningioma population, typical MRI signal intensity characteristics, including an intense homogenous contrast enhancement, were observed. In all the meningioma cases, except for one, there was no blooming artifact due to intratumoral hemorrhage within the mass lesions on SWI images. In only one meningioma case, SWI revealed hypointense microhemorrhages within the mass lesion. Following surgical procedures and tumor resections, pathology specimens were evaluated and absence or presence of intratumoral microhemorrhages were detected. These results were significantly correlated with the SWI findings. We obtained 100% sensitivity, 92.8% specificity, and 98.6% accuracy in terms of differentiating VSs from meningiomas located in the CPA cistern by using the SWI sequence.
DISCUSSION AND CONCLUSION: Meningiomas and VSs are the two most common masses of the CPA cistern and, in some cases, it seems to be difficult to reach an accurate diagnosis with conventional MRI sequences. The SWI can be helpful to solve this problem by demonstrating whether intratumoral microhemorrhages are present or not within mass lesions and, thus, can help to assume a probable accurate diagnosis prior to surgery.

5.The role of Helicobacter pylori and gastroesophageal reflux disease in otitis media with effusion and evaluation of MUC4, MUC5B mucin genes and inflammatory cytokines in guinea pig middle ears
Emin Eren, Mustafa Deniz Yılmaz, Yeşim Çekin, Arsenal Sezgin Alikanoğlu, Hülya Eyigör, Gamze Öztürk Yılmaz, Ömer Tarık Selçuk
doi: 10.5606/Tr-ENT.2020.22043  Pages 131 - 139
INTRODUCTION: This study aims to investigate the role of Helicobacter pylori (H. pylori) and gastroesophageal reflux disease (GERD) in otitis media with effusion (OME) and to examine the MUC4, MUC5B mucin genes in the guinea pig middle ears to analyze the inflammatory cytokines including tumor necrosis factor-alpha (TNF-a), interleukin (IL)-1beta (IL-1b), and IL-8.
METHODS: This study was conducted using eight guinea pigs. In the experimental group, H. pylori ATCC strain culture was injected transtympanically with microscopic guidance. The animals in the control group were injected with phosphate buffered saline (PBS) solution transtympanically. At 12, 24, 48, and 168 h after the injection, transtympanic PBS solution injection and aspiration of the middle ear were applied to all animals. After decapitation, the samples were taken.
RESULTS: In the histopathological examination, grading according to the degree of inflammation showed no statistically significant difference between the two groups (p>0.05). No statistically significant difference was determined in the analysis results of MUC4 and MUC5B genes in the middle ears of the two groups (p>0.05), the right and left ear values of IL-8, IL-1b, and TNF-a (p=0.999, p=0.610, and p=0.691, respectively).
DISCUSSION AND CONCLUSION: Based on our study results, there was no relationship between H. pylori injection in the middle ear and the histopathological changes of the middle ear mucosa. The results of the analysis of MUC4, MUC5B genes, and the inflammatory cytokines did not support the cause-and-effect relationship between H. pylori and OME.

6.Acupuncture an alternative treatment for patients with refractory sudden sensorineural hearing loss
Elif Kaya Çelik, Nuray Gülgönül, Kemal Keseroglu, Murad Mutlu, Güleser Saylam, İstemihan Akın, Mehmet Hakan Korkmaz
doi: 10.5606/Tr-ENT.2020.85047  Pages 140 - 146
INTRODUCTION: This study aims to investigate the effect of acupuncture treatment on hearing and tinnitus in patients with sudden sensorineural hearing loss (SNHL) refractory to treatment.
METHODS: Between January 2013 and May 2015, a total of 25 patients (8 males, 17 females; median age: 43.3 years; range, 18 to 65 years) resistant to medical treatment who underwent acupuncture as salvage therapy were retrospectively analyzed. The patients were evaluated with pure-tone audiometry, Speech Discrimination Score (SDS), and Tinnitus Handicap Inventory (THI) at pre-treatment (T0), and after 10th (T1) and 20th sessions (T2) of acupuncture.
RESULTS: Hearing loss evaluated according to the four-frequency pure-tone average (PTA; 500, 1,000, 2,000, and 4,000 kHz) showed a statistically significant improvement at the end of the 10th session of acupuncture (p=0.017). There was also a significant improvement in the PTA values of the worst three consecutive frequencies at the end of the 20th session (p=0.034). A significant improvement in SDS (p=0.022) and THI (p<0.001) was found at the end of the 20th session.
DISCUSSION AND CONCLUSION: Acupuncture treatment yields promising results in the improvement of PTA. The therapeutic effect of acupuncture is also evident in the treatment of tinnitus secondary to SNHL.

7.Prognostic value of vestibular evoked myogenic potential and distortion product otoacoustic emission tests in patients with a diagnosis of sudden hearing loss: A preliminary report
Bekir Bilgi, Mustafa Deniz Yılmaz, Hülya Eyigör, Omer Tarik Selcuk, Üstün Osma, Levent Renda, Ünal Gökalp Işık
doi: 10.5606/Tr-ENT.2020.06078  Pages 147 - 157
INTRODUCTION: This study aims to investigate whether vestibular evoked myogenic potentials (VEMPs) and distortion product otoacoustic emissions (DPOAEs) have prognostic values in the follow-up of patients diagnosed with idiopathic sudden sensorineural hearing loss (ISSNHL) with audiological tests.
METHODS: Between June 2013 and January 2014, a total of 27 patients (11 males, 16 females; mean age: 44.9±13.8 years; range, 18 to 60 years) diagnosed with ISSNHL at their first admissions and underwent VEMP and DPOAE tests were included. As the treatment protocol, steroid treatment combined with hyperbaric oxygen therapy was initiated in all patients. At the second month of the treatment, all patients underwent VEMP and DPOAE tests once again. Hearing recovery was evaluated based on the hearing improvement, compared to the unaffected contralateral ear.
RESULTS: The median recovery rate was statistically significantly higher in the patients with normal pre-treatment VEMP test results than those with abnormal VEMP test results (p=0.023). The median recovery rate was statistically significantly higher in the patients with normal post-treatment VEMP test results compared to those with abnormal post-treatment VEMP test results (p=0.031). The median recovery rate was also statistically significantly higher in the post-treatment DPOAE test positivity than the post-treatment DPOAE test negativity (p<0.001).
DISCUSSION AND CONCLUSION: Our study results suggest that, in the follow-up of the prognosis of ISSNHL disease, VEMP test may have a prognostic value, while DPOAE test is an important parameter which can be used in the monitorization of the disease.

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