We compared the preoperative findings of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) with those observed during surgery to determine their value for cochlear implant patients.A retrospective assessment was made on preoperative HRCT and MRI scans of 124 cochlear implant patients (71 males, 53 females; mean age 15 years; range 2 to 63 years). Congenital cochlear anomalies, cochlear ossification, new bone formation in the middle ear, and structures in the internal auditory canal were evaluated and compared with intraoperative findings.Cochlear anomalies detected in five patients by HRCT and MRI were confirmed intraoperatively. Cochlear ossification encountered in six patients during surgery was only demonstrated in four patients; HRCT and MRI scans only showed a narrow basal turn in the remaining two patients. During surgery, eight patients were found to have cochlear fibrosis: this finding was documented in five patients (62.5%) by MRI, and in none by HRCT scans.Although HRCT provides valuable information for surgical planning, its limitations may justify the additional use of MRI before cochlear implantation.
Evaluation of the parental perspective regarding cochlear implants and the child's progress after a minimum of 1 year after cochlear implantation.A closed-set questionnaire was used to assess the parental point of view. The questionnaire that was mailed to families included the following sections: decision to implant, process of implantation, positive effect of the implant, communication, supporting the child, self-reliance, well-being and happiness, social relationships, education, and pre- and postoperative services provided by the implant center.The study was conducted at SSK Ankara Hospital, which is a tertiary care center.Parents of 28 children with congenital deafness or who became deaf before the age of 3 years and received cochlear implantation were included in the study. To obtain reliable information, selected patients had a minimum of 1 year experience after implantation. The subjects were the parents of a group of children including 19 boys and 9 girls with ages ranging from 2 to 13 years (mean, 5.07 years; standard deviation, 2.33 years). The period of cochlear implant usage ranged from 12 to 30 months (mean, 19.5 months; standard deviation, 15.95 months).Assessment of parental view about cochlear implantation.Of 28 questionnaires sent, 27 were returned. Making decision for cochlear implantation was one of the most stressful steps for the parents. Although speech and language development was the major concern, parents reported outstanding improvement in communication skills, social relationships, and self-confidence for their child. All the families were anxious about a possible device failure, and maintenance of the cochlear implant equipment was another major concern.During pre- and postimplantation processes, parents provide an important link between the child and professional staff and have a vital role in the child's life and rehabilitation. The parental perspective presented in this study can be useful to the implant centers to revise their practice accordingly and improve the information given to candidate families.
We evaluated our surgical approach to the identification of the recurrent laryngeal nerve (RLN) under the guidance of operation microscope and RLN dissections during thyroidectomy.Twenty-three patients (20 females, 3 males; mean age 37 years) undergoing thyroidectomy were included in the study. Thirty RLN dissections were performed, being unilateral in 16 patients, and bilateral in seven patients. The recurrent laryngeal nerves were identified at the inferior thoracic inlet with the use of the operation microscope having an ocular lens of 250 mm, followed by a total dissection up to the laryngeal entrance. Endoscopic laryngeal examinations were performed for vocal cord movements one day before surgery and postoperatively on days 1, 3, and 7.No abnormal vocal cord movements were detected preoperatively. Following surgery, none of the patients developed persistent RLN paralysis. Two patients exhibited transient vocal cord paralysis (limitation in vocal cord movements). The use of the operation microscope for RLN dissections resulted in prolongation of the operation time ranging from 15 to 40 minutes for each side, which tended to decrease with enhanced experience of the surgeon.The use of the operation microscope enables safe RLN dissections during thyroidectomy operations.
Tonsil and adenoid core cultures were compared and beta-lactamase producing bacteria were determined in patients with chronic adenotonsillitis.Thirty-two patients (21 boys, 11 girls; mean age 5 years) with chronic adenotonsillitis underwent elective adenotonsillectomy. The core swaps of tonsil and adenoid tissues were obtained under sterile conditions and were inoculated in 5% sheep blood agar, eosin methylene blue agar, and chocolate agar plates. The frequency of beta-lactamase producing isolates were assessed.Staphylococcus aureus was the most common pathogen both in tonsil and adenoid core cultures. Among pathogenic bacteria isolated from tonsil (n=27) and adeonid (n=22) cultures, the same strains were isolated in 20 cultures (75%). The frequencies of beta-lactamase producing bacteria were 44% and 41% in tonsil and adenoid core cultures, respectively. S. aureus was associated with beta-lactamase production in 88% and 100% in tonsil and adenoid tissues, respectively.Differences between tonsil surface and core bacterial flora may have implications in the etiopathogenesis and treatment of chronic tonsillitis. The range of species isolated seems to be similar for both chronic tonsillitis and adenoiditis.
We evaluated the efficacy of combined medical treatment in cases with bilateral nasal polyposis without a history of any surgical or medical treatment.Twenty-five patients (19 males, 6 females; mean age 45 years; range 30 to 60 years) who had not received any treatment for bilateral nasal polyposis were included. Treatment was comprised of an oral anti-histaminic agent (single dose daily for 3 weeks), and a topical steroid (as a nasal spray, twice daily for 6 months) and a single dose of intramuscular systemic steroid. Patients who did not respond to this therapy at the end of three weeks were administered a macrolide antibiotic (clarithromycin). The results were evaluated before treatment, and three weeks and six months after treatment with the use of a patient questionnaire, computed tomography and endoscopic examination findings.The patients' complaints improved by 85.5% and 79% at the end of three weeks and six months, respectively (p<0.005). Radiologic improvement was found to be 64% at the end of six months (p<0.005). The overall decrease in the size of the polyps was significant (p<0.005). No treatment-associated complications were encountered.Significant improvement achieved favors the use of combined medical treatment before surgery in selected patients with nasal polyposis.
