Parotid gland involvement as a presenting feature of Wegener's granulomatosis.

Salivary gland involvement is a rare presenting clinical feature of Wegener's granulomatosis (WG). Early recognition and identification of any unusual presentations of WG may enable the early commencement of appropriate treatment. We report a case in which the initial manifestation of the disease was parotid gland swelling, and discuss the management of the patient. WG should be considered in the differential diagnosis when salivary gland enlargement occurs with other otolaryngological symptoms.

AIDS-related primary Kaposi sarcoma of the nasopharynx.

Primary nasopharyngeal Kaposi sarcoma is extremely rare, as only 1 case has been previously reported in the literature. We report a new case, which occurred in a 37-year-old man with a known history of acquired immune deficiency syndrome (AIDS). The patient presented with complaints of recurrent epistaxis and postnasal hemorrhage. Endoscopic examination detected a bluish, smooth, firm, nonpulsatile mass in the nasopharyngeal wall. Histopathologic findings on biopsy were consistent with Kaposi sarcoma. The tumor was successfully treated with radiotherapy. Kaposi sarcoma should be considered in the differential diagnosis of any AIDS patient who presents with recurrent unilateral nasal bleeding.

[Hemodynamic effects of local anesthetics with adrenaline during septal surgery]. / Nazal cerrahide adrenalinli lokal anestetiklerin hemodinamik etkileri.

OBJECTIVES: We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal surgery. PATIENTS AND METHODS: In a prospective, controlled design, administration of local anesthetics was performed with and without adrenaline in 39 patients and 10 patients, respectively, undergoing septal surgery. Plasma adrenaline concentrations were measured before anesthesia, and after 2, 5, and 10 minutes from anesthesia. The patients were monitored with respect to pulse rate, electrocardiographic findings, and blood pressure. RESULTS: Preoperative plasma adrenaline levels were similar in patients receiving local anesthetics with or without adrenaline (0.8 nmol/l vs 0.7 nmol/l). Following adrenaline administration, adrenaline levels showed significant increases to 2.2, 1.9, and 1.7 nmol/l after 2, 5, and 10 minutes, respectively (p<0.001), whereas they remained similar in the control group. No side effects related to adrenaline use were detected. CONCLUSION: Despite systemic absorption of local injections, adrenaline-related side effects during septal surgery are extremely rare when the patients are closely monitored.

Does erythropoietin augment noise induced hearing loss?

Noise-induced hearing loss may result from excessive release of glutamate, nitrogen oxide and reactive oxygen species. The effects of these factors on the inner ear may potentially be prevented or reduced by erythropoietin (EPO), as indicated by previously demonstrated neuro-protective effects of EPO upon damage to the central nervous system and the retina. This paper reports three separate trials, conducted to investigate the hypothesis that noise-induced hearing loss is prevented or reduced by erythropoietin. The trials employed three different modes of drug application, different administration time windows and different rodent species. In trial 1, guinea pigs were exposed to 110dB SPL, 4-20kHz wide band noise (WBN) for 8h. EPO was administered to the round window membrane 24h after noise exposure, either sustained by pump for a week or by single dose middle ear instillation. In trial 2, rats were exposed to 105dB SPL, 4-20kHz WBN for 8h. EPO was administered by single dose middle ear instillation 1 or 14h after noise exposure. In trial 3, rats were exposed to 105dB SPL, 4-20kHz WBN for 8 or 3x8h. EPO was injected intraperitoneally 1h before noise exposure. Oto-acoustic emissions and auditory brainstem responses (at 16kHz) were recorded before and after noise exposure in all trials. The noise exposure induced a hearing loss in all animals. In trial 1, no recovery and no improvement of hearing occurred in any treatment group. In trial 2 and 3, a partial hearing recovery was seen. However, the hearing loss of the EPO treated animals was significantly worse than controls in trial 2. In trial 3, the hearing of the EPO treated animals exposed for 3x8h was significantly worse than controls. Thus, surprisingly, the results from 2 of the 3 present trials indicate that erythropoietin may in fact augment noise-induced hearing loss. This is contradictory to the beneficial effect of EPO reported by the vast majority of studies on stressed neural tissues. EPO administration may alter the blood flow dynamics of the cochlear vascular bed during or after noise exposure, by a potential induction of vasoconstriction. This may be the cause of the surprising findings.

[Isolated inverted papilloma of the sphenoid sinus: a case report]. / Sfenoid sinüsün izole inverted papillomu: olgu sunumu.

Inverted papilloma is a rare benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin, whereas paranasal sinuses are frequently involved by extension. In contrast, primary sinus inverted papillomas have rarely been reported. The present study describes a 52-year-old man that presented with a one-year history of unilateral nasal obstruction, nasal discharge, epistaxis, occipital headache and decreased sense of smell. After nasal endoscopic examination, computed tomography was taken and endoscopic biopsy was performed which demonstrated isolated inverted papilloma of the left sphenoid sinus. Tumor was taken via transnasal endoscopic sphenoidotomy. No evidence for recurrent disease was seen after 12 months of follow-up and his symptoms were completely relieved. Endoscopic transnasal sphenoidotomy remains an effective treatment for these lesions.

[Endoscopic surgery of sphenochoanal polyp]. / Sfenokoanal polibin endoskopik cerrahisi.

Sphenochoanal polyp is a rare entity originating from the sphenoid sinus. It may be confused with an antrochoanal polyp on anterior rhinoscopy. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. We present a case of sphenochoanal polyp in a child that was operated by endonasal endoscopic approach. She was free of symptoms after surgery. No complications and recurrences were observed at 16 months of follow-up periods respectively.

Sternocleidomastoid muscle flap reconstruction during parotidectomy to prevent Frey's syndrome and facial contour deformity.

We studied the incidence of Frey's syndrome and facial contour deformity in two groups of patients who had undergone superficial parotidectomy. One group was made up of 12 patients who were randomized to undergo reconstruction of the surgical defect with a sternocleidomastoid muscle flap; the other 12 patients did not receive a flap. All 24 patients were evaluated via a short questionnaire, the starch-iodine test, and a visual examination. On the questionnaire, none of the 24 patients said they experienced abnormal facial sweating, flushing, or warmth while eating, although 6 of the 12 patients in the nonflap group had a mildly positive starch-iodine test. No patient in the flap group had a positive test. The difference between the two groups was statistically significant (p < 0.05). No statistically significant difference was seen between the two groups with respect to cosmetic results.

Erythropoietin and erythropoietin receptor expression in the guinea pig inner ear.

The erythropoietin receptor (EPOR) is expressed in the brain and erythropoietin (EPO) has been shown to have neurotrophic and neuroprotective functions in the central nervous system and in the retina. These findings may be applied to the inner ear, pending EPO receptor presence. Accordingly, this study determines expression of EPO and EPOR in the inner ear of the guinea pig. Normal guinea pig inner ears were processed for immunohistochemistry, using poly-clonal antibodies against EPO and the EPO receptor. EPO expression was exclusively found in most, but not all spiral ganglion neurons. Expression of the EPO receptor was found in the cytoplasm of the inner and outer phalangeal cells (Deiters' cells), as well as the inner sulcus cells and the supporting cells of the organ of Corti (Hensen, Claudius and some Boettcher cells). Some spiral ganglion neurons or glial cells expressed the receptor, as did spiral ligament fibrocytes, some intermediate cells of stria vascularis and the endothelial cells of some modiolar vessels. No parts of the vestibular system stained positive for either antibody. We conclude, that EPO is expressed by spiral ganglion neurons and that the EPO receptor is widely expressed by several cell types within the guinea pig cochlea. We hypothesize on the existence of a local paracrine system and that EPO treatment may be feasible following inner ear damage.

Effect of intranasal triamcinolone acetonide on bronchial hyper-responsiveness in children with seasonal allergic rhinitis and comparison of perceptional nasal obstruction with acoustic rhinometric assessment.

OBJECTIVE: Many patients with allergic rhinitis (AR) have bronchial hyper-responsiveness (BHR), and seasonal variation of BHR has been demonstrated in these patients. We aimed to investigate how BHR in children with seasonal AR is modified by triamcinolone acetonide aqueous nasal spray (TANS) therapy during the pollen season. A secondary aim was to assess the efficacy of TANS on nasal congestion by acoustic rhinometry and symptom scores. METHODS: A total of 34 children aged 7-18 years with grass pollen-induced AR and 18 age and sex-matched healthy controls were included in study. The patients were divided into the following two subgroups: 22 patients who had AR only; and 12 patients who had AR and asthma. All of them had a baseline BHR (PC20FEV1 methacholine < 8mg/ml). All patients received 220 microg TANS once daily for 4 weeks following a 1-week run-in period. Nasal patency was measured by acoustic rhinometry and patients recorded their nasal obstruction scores in a diary. RESULTS: There was no significant difference at baseline pulmonary function test parameters between the patients and the healthy control children. None of the control subjects had BHR. Asthmatic children with AR had significantly reduced baseline PC20FEV1 when compared with the AR only group [mean +/- S.E.M., (1.60 +/- 0.57 mg/ml versus 2.93 +/- 0.42 mg/ml, P = 0.021)]. The mean PC20FEV1 values increased slightly at the end of treatment in both group (from 1.60 +/- 0.57 mg/ml to 3.25 +/- 1.11 and from 2.93 +/- 0.42 mg/ml to 3.93 +/- 1.41 mg/ml), but the change was not statistically significant. TANS produced substantial symptomatic recovery in nasal obstruction according to patients' daily diary assessments, and significantly improved all objective acoustic rhinometry parameters. CONCLUSIONS: Once-daily intranasal TANS 220 microg effectively controlled nasal obstruction in children with seasonal AR according to subjective and objective assessments, and blocked the increase in BHR to methacholine after high-load natural pollen exposure. There was no correlation between patients' own subjective assessment of nasal obstruction and objective acoustic rhinometric assessment.

The significance of ferritin, lipid-associated sialic acid, CEA, squamous cell carcinoma (SCC) antigen, and CYFRA 21-1 levels in SCC of the head and neck.

OBJECTIVES: We investigated the value of some tumor markers in the diagnosis and treatment follow-up of squamous cell carcinoma of the head and neck. PATIENTS AND METHODS: Ferritin, lipid-associated sialic acid (LSA), carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) antigen and CYFRA 21-1 levels were determined in 28 patients with squamous cell carcinoma and in a control group of 20 patients with benign lesions of the head and neck. The measurements were made before treatment and in the first and third months of treatment. RESULTS: The sensitivity rates were as follows: 10.7% for ferritin, 89.3% for LSA, 21.4% for CEA, 42.9% for SCC antigen, and 14.3% for CYFRA 21-1. The specificity was 100% for all the markers. The sensitivity increased to 96.4% when CEA and LSA were used in combination. Declines in the levels after treatment were significant for ferritin, CEA, SCC antigen, and LSA. No significant relationship was found between the marker levels and lymph node metastasis, stage, and histologic differentiation of the tumors. Only ferritin and LSA levels were correlated with tumor size. Squamous cell carcinoma antigen was the only marker that manifested high levels in patients who developed locoregional recurrence and/or mortality. CONCLUSION: Of the markers studied, LSA, CEA and SCC antigen may be of value in the evaluation of squamous cell carcinoma of the head and neck. Sensitivity and specificity rates may increase when they are used in combination.

Thyroid gland invasion in advanced laryngeal and hypopharyngeal carcinoma.

OBJECTIVES: To assess the rate of thyroid gland invasion and the need for thyroidectomy in advanced laryngeal and hypopharyngeal carcinomas that require total laryngectomy. PATIENTS AND METHODS: Between 1994 and 2001, 129 total laryngectomy with ipsilateral hemithyroidectomy and 14 total laryngopharyngectomy with total thyroidectomy operations were performed for primary squamous cell carcinoma of the larynx and hypopharynx. In the surgical specimens of the patients, the presence of tumor invasion to the thyroid cartilage and thyroid gland was evaluated retrospectively by light microscopic examination. RESULTS: None of the laryngeal carcinoma patients had thyroid gland invasion whereas eight (57%) hypopharyngeal carcinoma patients had thyroid gland invasion. Twenty patients (16%) had evidence for thyroid cartilage invasion in the laryngeal carcinoma group. There were only three cases (21%) with thyroid cartilage invasion in the hypopharyngeal carcinoma patients. CONCLUSION: There may be no need for performing thyroidectomy in all total laryngectomy cases. We recommend thyroidectomy during total laryngectomy in laryngeal carcinoma cases with subglottic extension and advanced hypopharyngeal tumors. Except for these two conditions, the assessment of extralaryngeal extension and thyroid gland invasion will guide whether thyroidectomy should be performed or not.

[Epiglottic anteversion in the etiology of globus pharyngeus and its surgical management]. / Globus faringeus etyolojisinde epiglot anteversiyonu ve cerrahi tedavisi.

OBJECTIVES: To define the role of epiglottic anteversion in the etiology of globus pharyngeus (GP) and to evaluate the effectiveness of laser partial epiglottectomy in its treatment. PATIENTS AND METHODS: Four patients who admitted to our clinic between 2001 and 2003 with the complaint of GP underwent laryngoscopic examination, which revealed a structurally anteverted epiglottis that was in contact with the tongue base and vallecula. After ruling out other etiologic factors of GP, the patients were operated on under general anesthesia and laser partial epiglottectomy was carried out. In this procedure, the part of the epiglottis 1 cm from the free margin, forming the contact points with the tongue base and vallecula was excised with laser. RESULTS: Three patients were symptom-free totally, while one patient reported a partial cure. CONCLUSION: Epiglottic anteversion should be kept in mind in the etiology of GP. Laser partial epiglottectomy may be helpful in the treatment of selected cases.

Hamartoma of the larynx: an unusual cause of upper airway obstruction.

Hamartomas are rare lesions in the larynx. Both clinical and histopathological findings may be misleading to both the physician and the pathologist in terms of diagnosis. A 51-year-old female with the complaints of nonproductive cough and severe dyspnea lasting for a year was found to have a subglottic, submucosal mass almost totally obstructing the laryngeal lumen. Excisional biopsy was performed under suspensory direct laryngoscopy. Histopathological examination showed numerous, large, distended blood vessels, some of which had prominent thickened walls and mature adipose tissue beneath the surface epithelium. The final diagnosis was hamartoma, but we discussed its validity and other possible identifications in accordance with the literature.

[The effects of pharyngeal neurectomy and cricopharyngeal myotomy on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy]. / Horizontal supraglottik larenjektomi uygulanan hastalarda farenjeal nörektomi ve krikofarenjeal miyotominin ameliyat sonrasi yutma fonksiyonu üzerine etkileri.

OBJECTIVES: We compared the effects of pharyngeal neurectomy (PN) and cricopharyngeal myotomy (CPM) on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy (HSL). PATIENTS AND METHODS: The study included 20 male patients (mean age 53 years; range 39 to 67 years) who underwent HSL for squamous cell carcinoma of the larynx. Tumor stages were T1 in two, T2 in 16 , and T3 in two patients. None had received radiotherapy before surgery. In order to decrease cricopharyngeal muscle spasm following HSL, the patients were randomly chosen for CPM (n=11) and PN (n=9). The two groups were compared with respect to the time to postoperative oral food intake. RESULTS: No significant difference was found with respect to the time to postoperative oral feeding (mean 27 days, range 16 to 45 days in the CPM group; mean 25 days, range 16 to 36 days in the PN group; p>0.05). No significant relationship existed between primary tumor stages and the time to oral feeding (p>0.05). No complications were encountered in the two patient groups. CONCLUSION: In supraglottic partial laryngectomies, PN seems to be as effective as CPM to decrease postoperative cricopharyngeal muscle spasm, with additional advantages of ease and safety.

Lymphatic metastasis to the supraretrospinal recess in laryngeal squamous cell carcinoma.

In order to evaluate lymphatic metastasis to the supraretrospinal recess (SRSR) in laryngeal squamous cell carcinoma (SCC), we separately dissected SRSR lymph nodes and submitted them to pathological examination. Fifty-three lateral neck dissections (LNDs), 2 radical neck dissections (RNDs), and 19 modified RNDs were performed in 49 previously untreated patients with laryngeal SCC. The nodal status of the patients was N0 in 29 patients, N1 in 17, and N2 in 3. The neck was pathologically positive in both RNDs (100%), in 7 of 19 modified RNDs (37%), and in 7 of 53 LNDs (13%). No SRSR lymph nodes were positive in any of the dissection materials. No metastasis was found in the SRSR lymph nodes in the N0 necks treated with LND, and none was found even in N1 and N2 necks treated with RND or modified RND. We conclude that the SRSR may be left undissected during treatment of an N0 neck with LND so that accessory nerve dysfunction can be minimized and operative time can be saved.