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Öğe Acoustic impedance study of peritubal myoclonus(Taylor & Francis As, 2002) Yetiser, S.; Kazkayasi, M.; Civitci, D.An audible clicking sound coexistent with the contractions of the peritubal muscles is thought to be an isolated form of palatal myoclonus that presents with myoclonal contractions of the soft palate, larynx, pharynx and, sometimes, cervicofacial area. Acoustic impedance measurements, by demonstrating the relation between the muscle contract ions and the clicking noise, represent one of the ways in which the diagnosis can be confirmed. This paper reports the impedance changes following various maneuvers and simultaneous electromyography recordings in four patients with peritubal myoclonus and confirms the accuracy and simplicity of these tests. The pathology of peritubal myoclonus and its treatment options are discussed.Öğe Facial nerve paralysis due to chronic otitis media(Lippincott Williams & Wilkins, 2002) Yetiser, S.; Tosun, F.; Kazkayasi, M.Objective: To present the characteristics of facial paralysis caused by chronic otitis media. The role of cholesteatoma. bony dehiscence, the duration of the disease, and the results of surgical therapy in facial paralysis were reviewed. Study Design: Retrospective case review. Setting: Tertiary care referral center. Patients: A total of 24 patients (6 women, 18 men: age range. 17-74 yr) with facial paralysis were included in the study. Intervention: Canal wall down mastoidectomy was performed in 14 patients (58.3%), modified radical mastoidectomy was performed in seven patients (25%), and intact canal wall mastoidectomy was performed in three patients (16.7%). All patients had decompression of the fallopian canal from the geniculate ganglion to the stylomastoid foramen without opening the epineural sheath. Results: Eighteen patients (75%) had gradual onset of facial paralysis. The most common associated symptom with facial paralysis was vertigo in six patients. Twelve patients (50%) had no associated symptoms. Facial paralysis was the sole complication in 2 1 patients (87.9%), Three patients had multiple complications, Labyrinthitis was the most common associated complication. Facial paralysis was associated with congenital cholesteatoma in one patient. Four-teen patients (58.3%) demonstrated dramatic recovery within 3 months after surgery. Intraoperatively. cholesteatomas were found in 17 of the patients (70.8%). The fallopian canal was intact in four patients (none of them had a cholesteatoma), and 20 patients had bone destruction or dehiscence (three patients had no cholesteatoma). The tympanic segment was the most common site of involvement in 14 patients (58.3%). Conclusion: A middle ear cholesteatoma was present in the majority of patients with facial paralysis caused by chronic otitis media, Gradual onset of facial paralysis was the most frequent pattern, Facial paralysis presented poor prognosis regardless of the presence of a cholesteatoma, There was no statistical difference among the results of surgical techniques.Öğe Immunologic abnormalities and surgical experiences in recurrent facial nerve paralysis(Lippincott Williams & Wilkins, 2002) Yetiser, S.; Satar, B.; Kazkayasi, M.Objective: To document immunologic findings in patients with recurrent facial paralysis (RFP) and to compare the results of the surgery with the results of medical treatment. Study Design: Retrospective case review. Setting: Tertiary care referral center. Patients: Nine patients with RFP were reviewed. Intervention: Patients underwent nonspecific antibody detection, protein electrophoresis (in blood and cerebrospinal fluid [CSF]) and oligoclonal band determination for immunoglobulin G, A, and M (in CSF). The extended subtotal facial nerve decompression via the transmastoid and transattic route was performed in four patients. Five patients received medical treatment only (steroids, vitamin 13). Results: Two patients had the complete and four patients had the oligosymptomatic form of Melkersson-Rosenthal syndrome. The other three patients were diagnosed with idiopathic RFP. Serum immunoglobulin G was high in seven of nine patients (77%). CSF protein electrophoresis demonstrated an elevated albumin fraction in six of nine patients (66%). CSF immunoglobulin G was high in four of nine patients (44%). The oligoclonal band in CSF was negative in all patients. Mean follow-up time was 5.2 +/- 2.6 years and 3 +/- 1.5 years for surgically treated patients and medically treated patients, respectively. None of the patients who underwent the surgery demonstrated recurrence. Although marked recovery was observed in patients who had received medical treatment, three of them had recurrence during the follow-up period. Conclusion: Serologic test results have demonstrated immune system involvement in cases of idiopathic RFP and in cases of Melkersson-Rosenthal syndrome, providing no distinction between the two. There was no sign substantiating local antibody production in CSF, which implies that the elevated antibodies in CSF were peripheral in origin. Although the serologic test results were not conclusive for a specific diagnosis, they support an immune-mediated pathogenesis. Despite the small number of patients who underwent the extended transmastoid facial nerve decompression, our follow-up data were suggestive for the prevention of recurrences.Öğe Magnetic resonance imaging of the intratemporal facial nerve in idiopathic peripheral facial palsy(Elsevier Science Inc, 2003) Yetiser, S.; Kazkayas, M.; Altinok, D.; Karadeniz, Y.The aim of this study was to investigate the prevalence of facial nerve involvement with gadolinium-enhanced magnetic resonance imaging (Gd-MRI) in patients with idiopathic peripheral facial palsy (IPFP), and to discuss the localization and the pattern of enhancement. A total of 13 patients (9 female, 4 male) with IFPF were included in this study. Topographic tests and electromyography (EMG) were performed, and MRI was taken. Ten subjects whose cranial MRIs were taken for nonorganic pathology served as the control group. Twelve of 13 paralytic facial nerves had enhancement on postcontrast images. Two facial nerves of the control group demonstrated enhancement. We found a correlation between the enhancement of the facial nerve and the time for recovery. The average time from the onset of facial palsy to the recovery in patients with enhancement was 14 weeks, whereas it was 6 weeks in patient with no enhancement. Finally, all patients had complete recovery of the facial nerve function. We concluded that contrast enhancement of the paralytic facial nerve can be a radiological sign of a neural inflammation and may indicate a prolonged recovery. (C) 2003 Elsevier Science Inc. All rights reserved.
