Impact of enuresis nocturna on health-related quality of life in children and their mothers

OBJECTIVE

Nocturnal enuresis (NE) is a common childhood disorder. As children age and NE persists, it may become more stressful for both them and their caregivers. The aim of the present study was to assess the impact of NE on the quality of life of children who were diagnosed with NE, and their mothers, and to compare the results with a healthy control group.

SUBJECTS AND METHOD

Eighty-two children with NE, and their mothers, and 93 healthy children and their mothers were enrolled in the study. The sociodemographic data were evaluated. The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL 4.0) were used to assess the children's health-related quality of life (HRQoL); and the World Health Organization Quality of Life Instrument; short form (WHOQOL-BREF) was used for the mothers' HRQoL.

RESULTS

The PedsQL 4.0 mean scores for the children with NE group were as follows: total score, 68.74; physical health score, 72.79; psychosocial health score, 66.56. The scores for the children in the control group were as follows: total score, 80.98; physical health score, 81.11; psychosocial health score, 80.88. The WHOQOL-BREF scores for the mothers of the children with NE were as follows: physical health score, 67.90; psychosocial health score, 62.66; social relationships score, 60.90; environmental area score, 61.04. The WHOQOL-BREF scores for the mothers in the control group were as follows: physical health score, 75.96; psychosocial health score, 72.39; social relationships score, 72.18; environmental area score, 67.44.

CONCLUSIONS

Nocturnal enuresis negatively affects the quality of life of both children and their mothers. Therefore, when physicians see children with enuresis, they should also be aware of the effect of NE on the mothers' quality of life.

Surgical implications of anatomical landmarks on the lateral surface of the mastoid bone

The aim of this study was to examine the relationships of the surgical landmarks on the lateral surface of the mastoid bone with the landmarks in a deeper location. Simple mastoidectomy was carried out without drilling over the linea temporalis inferior (LTI) on 20 adult temporal bones. The suprameatal spine, i.e., Henle spine (HS), variants were noted. Morphometric measurements were performed between these surgical landmarks, and their variations with pneumatization or HS types were evaluated. Three types of HS were identified: triangular, crest, absent. The HS-lateral semicircular canal distance was 15 mm on average and longer in bones with a triangular HS than a crest type HS (16.4 vs. 14.3 mm). The LTI was found to be located on average 4.7 mm inferior to the middle fossa dural plate (MFD). The LTI-MFD distance had a tendency to be longer in bones without an HS than with a crest type of HS (5.9 vs. 3.9 mm). Chorda tympani emerged from the facial nerve at the stylomastoid foramen in five specimens (25%). This anatomical organization was not correlated with the type of HS. Korner's septum (KS) was identified in nine bones (45%). It was present in eight of 16 (50%) bones with good pneumatization. No tendency for the existence of KS was found for any specific type of HS. This study confirms that the mastoid antrum is located 15 mm deep to the lateral surface of the mastoid bone. It should be expected to be longer in bones with a triangular HS. In addition, the MFD is located on average 5 mm above the LTI, which could be useful information for beginners or inexperienced surgeons. The ear surgeon should anticipate that the MFD might be longer in bones without an HS.

Radiologic anatomy of the sphenoid sinus for intranasal surgery

Endoscopic surgery of the sphenoid sinus can present the operator with a considerable challenge. The relationship of the sphenoid sinuses, in particular on the lateral wall, to the carotid artery, optic nerve, as well as the other anatomic structures, is of utmost importance. Surgical complications can occur because of a lack of orientation during dissection. To avoid the complications or lessen, somehow, the rate of complications, some described the technique consisting of the opening of the sphenoid sinus ostium medially. We studied 69 axial high resolution computed tomography (HRCT) of temporal bones to reveal the relationship of sphenoid sinus to the vital structures and to get some measurements in the sphenoid sinus. The lateral distance from the sphenoid ostium revealed that the lateral distance was about the distance between both ostea. We consider that in selected cases the dissection might be carried out laterally from the sphenoid ostium for safe enlargement of the ostium and approaching the sinus.

Organized hematoma of the maxillary sinus mimicking tumor

The authors present two cases of organized hematoma of the maxillary sinus. Both patients showed no bleeding abnormalities. Clinical symptoms, signs and radiologic appearance of the mass mimicked tumor during the initial diagnosis of the disease. To our knowledge, this is the first article describing organized hematoma in the maxillary sinus mimicking tumor without bleeding history and disorders. A provisional diagnosis of organized hematoma should be considered when a patient with history of epistaxis develops a slow-growing mass of the cheek and/or nasal obstruction.

Tympanic membrane and middle ear pathologic correlates in mucoid otitis media

OBJECTIVE

The goal of this study was to correlate tympanic membrane (TM) and middle ear (ME) pathologies in mucoid otitis media (MOM).

METHODS AND MATERIAL

Forty ears with MOM and 56 control ears were retrospectively evaluated for TM and ME pathologies. Comparisons of TM thicknesses in MOM versus control ears were correlated with the Student t test; chi(2) analysis was used to correlate pathologic findings of the TM and ME.

RESULTS

Thicknesses in all quadrants except the umbo were increased in MOM because of infiltration of inflammatory cells and fibrosis. The most common ME pathologies were granulation tissue and fibrosis. Significant correlations included (1) TM retraction and ME granulation tissue and fibrosis and (2) pars flaccida, posterosuperior, and anteroinferior thickness and ME granulation tissue and fibrosis.

CONCLUSION

TM changes are likely to occur in patients with otitis media with effusion (MOM), and their presence is a strong indication of underlying ME pathology.

Facial neuroma in the internal auditory canal

Authors presented two cases of facial neuromas in the internal auditory canal, one without facial palsy and the other with facial palsy. In both cases neuromas were occult and undiagnosed. Although in the first case neuroma was greater than the other, facial palsy was not developed. The mechanism of the facial palsy due to neuromas could not be clearly clarified.

Histopathologic features of the temporal bone in patients with cystic fibrosis

OBJECTIVES

To investigate the lower than expected incidence of otitis media in patients with cystic fibrosis (CF) through histopathologic evaluation of temporal bones and to document pathologic findings in the inner ears of patients with CF who received long-term administration of antibacterial and diuretic agents.

DESIGN

Clinical records of patients who died of CF were reviewed. Their temporal bones were sectioned, stained with hematoxylin-eosin, and examined histologically. Additional sections were stained with Alcian blue and periodic acid-Schiff for comparison of goblet cell densities from middle ears and auditory tubes of patients with CF with those of control temporal bones. Results were analyzed using the t test.

SUBJECTS

Twenty-one temporal bones from 11 patients with CF and 13 bones from 8 age-matched patients without CF were selected.

RESULTS

All temporal bones with CF had well-pneumatized mastoids. Temporal bones from 2 patients (3 ears) revealed histological findings of chronic otitis media with effusion. There was a statistically significant reduction in the density of goblet cells in the medial (P = .002) and lateral (P = .05) walls in patients with CF who had no otitis media histologically compared with control temporal bones. Two patients with CF who had otitis media had increased densities of goblet cells. Inner ear damage, due to ototoxic drugs, was seen in most of the temporal bones from patients with CF.

CONCLUSION

Low densities of goblet cells in temporal bones with CF may contribute reduced amounts of viscous mucus, which can lead to a low incidence of otitis media.

Congenital malformations of middle and inner ears of parabiotic twins

We describe herein the congenital malformations of the middle and inner ears in temporal bones of parabiotic, monozygotic twins. Temporal bones were removed from twin B, who had no fetal cardiac activity and was born dead at 23-4/7 weeks, and twin A, the donor or "pump" twin in intrauterine life, who died shortly after birth at 20-6/7 weeks. The temporal bones were processed routinely in celoidin, stained with hematoxylin and eosin, and examined by light microscopy. We found that twin B had Mondini's dysplasia with associated deformities of the middle ear and in general showed more developmental anomalies than twin A, and we conclude that Mondini's dysplasia with anomalies of the middle ear may occur in the parabiotic twin syndrome, and the abnormalities may be explainable as the result of vascular disturbance, which also causes other lesions in these unusual cases.

Endoscopic dacryocystorhinostomy without stents

OBJECTIVE

The aim of this study is to present our endoscopic DCR operation method without the use of silicone tubing and our results on the patients suffering from chronic epiphora with postsaccal stenosis.

METHODS

Endoscopic dacryocystorhinostomy operations were performed to 21 sides of 18 patients who had chronic epiphora. No silicone tubing was used in any of the cases. In the postoperative healing period, the rhinostomy opening was maintained with frequent removal of nasal debris and using eyedrops. The patients were evaluated by fluoresceine test and endoscopic controls.

RESULTS

Symptomatic improvement was achieved in 19 out of 21 sides of the patients (90.5%) and the results were confirmed by the fluoresceine test under endoscopic control.

CONCLUSION

Our results of 21 sides of 18 cases underwent primary DCR without stents are as successful as those reported in the literature and the technique seems to be promising.

Intramuscular hemangioma of the masseter muscle

Intramuscular hemangiomas (IMH) are uncommon tumors of the head and neck, but often occur in the trunk and extremities. When present in the head, the masseter muscle is the most frequently involved site, although constituting only 0.8% of all hemangiomas. Accurate preoperative diagnosis is uncommon without cytology or biopsy. A case of IMH of the masseter muscle in a 24-year-old Turkish woman is presented. Clinical, radiologic and histologic findings and treatment modalities are reviewed.

Sensorineural hearing loss associated with otitis media with effusion in children

Sensorineural hearing loss (SNHL) is known to occur in various types of otitis media. Although the mechanism by which SNHL develops in association with otitis media with effusion (OME) is unknown, several hypotheses have been advocated up to now. We reviewed the clinical records of children with otitis media with effusion (OME) to reveal the association with sensorineural hearing loss. The material consisted of 71 children (119 ears) who were diagnosed as having OME and gave reliable audiograms in our clinic during an 11 month period from February 1997 through January 1998. From these cases those which showed bone conduction loss of 25 dB or higher at any one of the frequencies of 250 through 4 kHz were selected and considered to be cases of SNHL. Eight cases (9%) which had temporary threshold shift (TTS) or permanent threshold shift (PTS) were considered to be etiologically related to OME. The clinical course in each of these cases with SNHL was reviewed and evaluated in detail. We noted that all children with TTS improved completely. The result of this study indicates that we have to be aware of a possible development of SNHL during the course of OME.

Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery

The purpose of this study is to determine some important variations and dangerous areas carrying risks for major complications, in the routine CT examination. We also made specific measurements to evaluate the individual differences. This prospective study consisted of 111 patients (222 sides). Eighty patients underwent coronal, and the rest coronal and axial CT. The depth of lamina cribrosa, its distance to the inferior turbinate, and the distance of anterior ethmoidal artery (AEA) either to the orbital roof or inferior turbinate were measured. Variations of the upper attachment of uncinate process were encountered in 23%. AEA coursed freely within ethmoidal cells in 43%. Anterior clinoid aeration was seen in 14%, optic canal bulging into the sphenoid sinus in 13% and an extreme medial course of the carotid canal in 12% of the patients. The mean depth of lamina cribrosa was 5.9 mm, and its mean distance to the inferior turbinate was 25.7 mm. The mean distance of AEA to the orbital roof was 13.7 mm, and to the inferior turbinate 30.05 mm. Anterior clinoid aeration correlated well with the variations of carotid and optic canals, statistically (p < 0.01). A detailed CT study will provide important information on the areas carrying risks of complications and the size of the area to be worked on.

Benign fibrous histiocytoma of the nasal septum

Among the non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, fibrous histiocytoma is rarely encountered. A 45 year-old male patient complaining about nasal obstruction and nasal swelling was seen in the hospital ENT department. On examination, there was a mass located on the right anterior part of the nasal septum, about 2 x 1 x 1 cm in size. The pathologic diagnosis was benign fibrous histiocytoma. In this article we discuss the clinical, radiological, histopathological characteristics of fibrous histiocytoma and its differential diagnosis.

Middle ear pathology in day-care centre children

BACKGROUND

Middle ear pathology, either otitis media with effusion or tubal dysfunction, is frequently seen in day-care centre children. Recognition and early treatment of this condition is crucial to the prevention of chronic otitis media, which is a major cause of hearing loss in later life.

OBJECTIVES

We aimed to reveal the incidence of silent otitis media in day-care centre children and to determine the predisposing factors, risk factors and the awareness of the parents of the middle ear disease of their children.

METHOD

Two hundred and thirteen children, aged 3-6 years, were screened in four daycare centres. A questionnaire was prepared that would reveal the predisposing factors. Information was gathered from both the parents and teachers. Children were examined by otoscopy, pneumotoscopy, tympanometry and X-rays for sinus pathology.

RESULTS

Forty-three of 213 children had middle ear pathology; 39 of them were confirmed by tympanometry; 56.1 % of children had some degree of sinus pathology. We revealed that, although most of the children do not have the risk factors, they develop middle ear pathology. Among the parents, 81.4% of them were unaware of the condition.

CONCLUSION

Early diagnosis of middle ear pathologies is necessary for prevention of future complications. In early stages the condition is silent. We emphasize the importance of the primary care physician's role in diagnosing the early stages of middle ear pathologies and recommend that teaching of otoscopic and pneumotoscopic skills should be part of the training for family physicians.

Histopathology of human temporal bone after cis-platinum, radiation, or both

Preserving organs by use of multiple modalities has become protocol in treating squamous cell carcinomas of the head and neck, but cis-platinum and radiation can impair hearing. To determine the effect of cis-platinum, radiation, or a combination of these treatments on the temporal bone, we studied histopathologic slides of 15 human temporal bones: four after cis-platinum, five after radiation, two after combined treatment, and four from normal controls. Hair cells and cells in spiral ganglia were counted in reconstructed organs of Corti. Lumen-to-diameter indexes in arterioles near facial nerves were quantified for four normal controls and seven irradiated patients. Available audiograms were compared. Decreased spiral ganglion cells, loss of inner and outer hair cells, and atrophy of stria vascularis were demonstrated in groups receiving cis-platinum, radiation, and combinations, compared with age-matched controls. Arterioles around facial nerves demonstrated fibrinous clots within the intima, endothelial proliferation, and hypertrophy and fibrosis of vascular walls in smooth muscle. Fibrosis in connective tissue was clearly progressive after radiation. Cis-platinum and radiation can contribute to otologic sequelae, including sensorineural hearing losses, vascular changes, serous effusion, or fibrosis. Prophylactic treatments and techniques to deliver them should be considered for protection of temporal bones and preservation of hearing after oncologic modalities.

Clinical-histopathological correlations of pitfalls in middle ear surgery

Significant anatomical variations within the middle ear are described as well as atypical histopathological findings in 13 selected human temporal bones. Bones studied included such vascular and bony abnormalities as carotid artery canal dehiscence, a high jugular bulb, persistent stapedial artery and facial nerve canal dehiscences. Bones also included obliterative otosclerosis, malleus head fixation and a variety of chronic inflammatory changes and/or sequelae. Those features considered to render cases prone to complications are detailed.

The variational anatomy of the external aperture of the human vestibular aqueduct

A study was undertaken to demonstrate the variational anatomy of the external aperture of the vestibular aqueduct in 90 human temporal bones obtained from 58 cadavers. Topographic landmarks of the posterior surface of the petrous bone are useful for general orientation and include the external aperture of the vestibular aqueduct, internal auditory meatus, sigmoid sinus, subarcuate fossa, superior petrosal sinus and cochlear canaliculus. We determined the mean distances from the external aperture of vestibular aqueduct to the above structures to be 10.98, 11.21, 9.42, 10.27 and 13.90 mm, respectively. Furthermore, the length of the external aperture of the vestibular aqueduct revealed significant differences between the right and left sides. The distances between the EAVA and certain anatomical structures on the posterior surface of the temporal bone should be taken into consideration during surgery. Knowing the variability of the position of the external aperture of the vestibular aqueduct may help surgeons avoid traumatizing, and thus producing inadvertent lesions to the hearing mechanism.

Significance of epidermoid formations in the middle ear in fetuses and children

OBJECTIVE

To determine the incidence, size, and location of epidermoid formations (EFs), which have been suggested to be precursors of congenital cholesteatomas, in temporal bones from fetuses and children.

DESIGN

We examined temporal bones from 226 fetuses and children up to the age of 10 years for the incidence, size, and location of EFs.

RESULTS

Twenty-five EFs were identified in middle ears of 3 fetuses, 7 neonates, 9 infants, and 2 children aged 2 and 3 years. There was a male-female preponderance of 5:4. Generally, we saw EFs between the anterosuperior edge of the eardrum and the anterior limb of the tympanic ring, but 4 were below the level of the handle of the malleus. Their widths ranged from 25 to 300 microns. Keratinization was not observed in any EF. Contrary to previous reports, we found EFs not only in ears of fetuses, but also in ears of infants and children.

CONCLUSION

Although EFs may persist in some ears, possibly developing into congenital cholesteatomas, our findings do not provide direct support for this concept.

Anatomical guidelines for intranasal surgery of the lacrimal drainage system

To facilitate identification of the nasolacrimal duct during intranasal surgery, we have determined the distances between the lacrimal drainage system and certain anatomical structures on the lateral wall of the nasal cavity. A total of 15 adult cadaver skulls were bisected mid-sagittally and evaluated morphometrically. In our specimens, the average distance from the natural ostium of the maxillary sinus to the nasolacrimal duct (NLD) was only 5.5 mm. This rather small distance should be taken into consideration, in order to prevent trauma of the NLD during surgical enlargement of the ostium of the maxillary sinus. The distances from NLD to the anterior surface of the bulla ethmoidalis, the free edge of the uncinate process and the attachment point of the middle turbinate on the lateral nasal wall were found to be 10.2 mm, 8.8 mm and 5.4 mm, respectively. Taking these distances into account, easy identification of the NLD during endonasal dacryocystorhinostomy surgery will be possible.

Canal wall down mastoidectomy: causes of failure, pitfalls and their management

Managing patients with failed canal wall down mastoidectomy, requires a meticulous approach to control the disease and restore hearing. The present article reviews the causes of failure of the primary procedure and pitfalls encountered in 105 patients referred to our centre for revision canal wall down mastoidectomy. At post-revision surgery there were no cases with residual or recurrent cholesteatoma. The failures in our revision procedure were due to tympanic membrane perforation which occurred in five per cent (n = 4) and intermittent otorrhoea in two per cent (n = 2). A dry cavity with adequate middle ear space allowed for optimum audiological function even in revision canal wall down procedures.

Surgical treatment of cholesteatoma in children

Treating cholesteatoma in children is still controversial. This article reviews 93 cases of pediatric cholesteatoma operated on from 1983 to 1991 in the Gruppo Otologico, Placenza, Italy, and details the results in 83 children who underwent the intact canal wall technique. During second-stage surgery, residual cholesteatoma was detected in 38% of patients. Recurrent cholesteatoma was detected in 10% of patients treated with the intact canal wall technique. Residual cholesteatoma was seen in the middle ear cleft in 63%, in the epitympanum in 26%, and in the mastoid in 11% of cases. Social hearing level (< 25 dB) was achieved in 85% of cases with suprastructure, whereas only 53% of patients without suprastructure had these levels. In the treatment of cholesteatoma in children by use of the intact canal wall technique, a preplanned second-look operation is mandatory to eradicate the disease.