A rare cause of acute severe upper airway obstruction that required endotracheal intubation: adenoid hypertrophy.

Adenoid hypertrophy is one of the common causes of upper airway obstruction in children. It usually presents with sleep-related breathing disorders and associated findings generally occur around the age of 4 years. However, the development of acute upper airway obstruction due to adenoid hypertrophy is extremely rare. Acute upper airway obstruction due to adenoid hypertrophy in a patient aged under 1 year is an extremely unexpected condition. The aim of this case report was to contribute to the literature by reporting the presence of adenoid hypertrophy causing severe acute airway obstruction leading to endotracheal intubation in a 7-month-old male patient.

Effects of submucosal PRP injection on wound healing in endonasal surgeries: an experimental study.

PURPOSE: To investigate the effects of submucosal platelet-rich plasma (PRP) injection on nasal mucosal wound healing after endoscopic sinus surgery. METHODS: 24 New Zealand white rabbits were randomly divided into three groups. To mimic surgery, injury was created using 3-mm punch forceps on ventral turbinate mucosa for all groups. Submucosal PRP was injected to the damaged mucosa in the first group (PRP group, n = 8), where 0.9% saline solution to the second group (saline group, n = 8) and no injection to the third one (control group, n = 8). All the animals were sacrificed 14 days after surgery; histopathological examination and hydroxyproline measurements were performed on the mucosa of all groups. RESULTS: Neutrophils, goblet cells, and collagen intensity were found significantly lower (p < 0.05) in PRP group than the control group. Also, the number of ciliary and goblet cells, and collagen intensity were found significantly lower (p < 0.05) in PRP group, than the saline group. In PRP group, hydroxyproline levels were found (p < 0.05) significantly lower than the saline and the control group, and no significant difference was found between the saline group and the control group (p > 0.05). CONCLUSION: There are many studies in literature showing the positive effects of PRP on wound healing. The results of this study also demonstrated positive effects of PRP on the nasal mucosa. According to these results, PRP injection to the injured nasal mucosa showed anti-inflammatory, mucus-softening, and synechia-reducing effects. Therefore, submucosal PRP injection after endonasal surgeries can be considered an effective application for maintaining nasal physiology.

National questionnaire on skills and techniques in pediatric tracheotomy surgery in Turkey.

OBJECTIVE: The aim of the study was to determine the differences in surgical preferences of ENT Surgeons in Turkey with regard to pediatric tracheotomy. DESIGN: Questionnaire study. PARTICIPANTS: ENT Surgeons. MATERIALS AND METHODS: The national multiple-choice questionnaire study included a total of 16 questions about physicians technical preferences, different methods and complications in pediatric tracheotomy surgery. It was planned and implemented with the support of a professional survey company (www.surveymonkey.com). RESULTS: The questionnaire was answered by 591 ENT Surgeons; the percentage of the physicians performing pediatric tracheotomies in the previous year was 59.6%. Forty point four percent (40.4%) of the physicians had not performed tracheotomies in the pediatric age group and 57.9% had not performed tracheotomies in patients under one year old. Seventy point six percent (70.6%) of the physicians who had performed tracheotomies had made vertical skin incisions, 69.5% of them had removed subcutaneous adipose tissue, 81.4% of them had retraction the thyroid isthmus area from their field of view; 83.9% of them had made a vertical incision to the trachea, 82.5% of them had applied a stay suture to the trachea and 4.7% of them had used additional techniques for stoma maturation. The intraoperative mortality, early complication, late complication, and total complication rates were 3.9%, 32.7%, 21.2% and 53.9 respectively. CONCLUSIONS: This is the first large-scale questionnaire study with data on pediatric tracheotomy techniques and the practices of ENT Surgeons at a national level. Common approaches were observed among the.

Right-Sided Complete Third Branchial Cleft Fistula.

Branchial cleft anomalies occur due to insufficient closure of cavities during embryogenesis. These anomalies consist of cysts, sinuses, and fistulas, with the rarest type being fistulas. A 29-year-old male presented at the authors' clinic with a right-sided complete third branchial cleft fistula. Fistula track excision surgery was successfully performed and no recurrence was observed in the 12-month follow-up after the surgery. While second branchial cleft fistula is the most common, third and fourth brancial cleft fistulas are extremely rare. In addition, they are usually incomplete and almost always on the left side.

The use of nasal trumpet as a non-invasive treatment method in congenital nasal stenosis.

Kemal Ö, Atmaca S, Bel-Çeçen A, Düzgün B, Aygün HC. The use of nasal trumpet as a non-invasive treatment method in congenital nasal stenosis. Turk J Pediatr 2017; 59: 210-213. Newborns and infants are dependent on nasal respiration and therefore, nasal obstructions may lead to life-threatening outcomes in this age group. Although the most common cause of nasal obstruction in newborns are choanal atresia, soft tissue edema, congenital nasal bone anomalies such as narrowness of the apertura piriformis and midnasal stenosis should be kept in mind. A 5-day-old infant was referred to our clinic with the complaints of respiratory problems. Physical examination revealed nasal bone hypoplasia and saddle nose deformity. In the endoscopic examination, the septum was seen to be deviated in an `S` shape and the nasal passages were almost completely closed. The paranasal CT examination reported significant narrowing of the airway in the central part of the nasal cavity. After application of nasal trumpet to both nasal passages, clinical recovery was determined in the patient and no pathology was determined during the follow-up period.

Thyroglossal Duct Cyst in a 3-Month-Old Infant: A Rare Case.

Thyroglossal duct cyst (TGDC) is the most common congenital midline neck mass in children. It usually becomes symptomatic following a respiratory tract infection and is usually diagnosed at 5 years of age. Thyroglossal duct cyst is rarely observed in less than 1-year-old infants. In this study, we present a 3-month-old infant with TGDC, who was administered multiple courses of antibiotic therapy for the hyperemic, draining, midline neck mass that had existed since he was 15 days old. Physical examination revealed an infrahyoid midline neck mass measuring 3×3 cm, which moved while swallowing and had a sinus opening in the overlying skin. The patient underwent Sistrunk operation under general anesthesia. Histopathologic examination revealed TGDC. One-year follow-up revealed no recurrence.

Effect of Mitomycin C on bFGF, TGF-ß1, KGF-1 Expressions after Myringotomy: An Animal Study.

OBJECTIVE: The purpose of this study was to evaluate the effect of topical mitomycin C (MMC) on growth factor expression in tympanic membrane (TM) wound healing. MATERIALS AND METHODS: Forty (20 male and 20 female) adult Wistar albino rats that varied from 250 to 300 g in weight were divided into five groups. In the first group, no intervention was performed, and the intact TMs were excised after the rats were sacrificed. In the other groups, both ears of rats underwent an electrocautery myringotomy procedure; MMC was applied to the right ears and saline to the left ones. In all groups, on the 3(rd), 7(th), 14(th), and 30(th) days, macroscopic examinations of TM patency and the expressions of transforming growth factor-ß1 (TGF-ß1), basic fibroblast growth factor (bFGF), and keratinocyte growth factor-1 (KGF-1) in TM epithelia, fibroblasts, and macrophages were performed by immunohistochemical staining and compared among the groups. RESULTS: Complete healing was significantly less in the MMC group with respect to the saline group on the 7(th) and 14(th) days (p<0.05). On immunohistochemical study, no significant differences in the expressions of bFGF or KGF-1 were observed among the groups with one exception; on the 3rd day, the expression of TGF-ß1 in macrophages was more elevated in the MMC group than in the saline group (p=0.001). CONCLUSION: Application of MMC to acute perforations of the TM delays closure and has significant effects on some growth factors for certain durations.

Management of subglottic hemangioma with propranolol.

Subglottic hemangioma is a rare but life- threatening condition which requires intervention. It generally starts proliferating in the first and second months of lifespan and whether there is a respiration problem or not, it causes biphasic stridor. Its diagnosis generally requires direct laryngoscopy or direct screening through bronchoscopy. This case report presents a 45-day-old girl who had subglottic hemangioma presenting with wheezing and stridor. Our case took propranolol with a dose of 2 mg/kg/day and within 48 h after the start of the treatment, obstructive symptoms started to alleviate considerably.

Are computed tomography and densitometric measurements useful in otosclerosis with mixed hearing loss? A retrospective clinical study.

The objective of the study was to investigate the relationship between extent of otosclerotic foci and audiological findings in otosclerotic patients with mixed hearing loss using high-resolution computed tomography (HRCT) and also to measure the density of bony labyrinth in otosclerotic patients and compared with control group. This was a retrospective study. Twenty-five patients with clinical otosclerosis and mixed hearing loss were included in the study. The average threshold of air-bone conductions (AC, BC) within the 0.5-4 kHz frequency range, and average air bone gap (ABG) were calculated. Eleven patients with normal HRCT who received cochlear implant were included in the study as the control group. The lesions in HRCT were staged according to their extension. Eight different points of the otic capsule in each patient were measured using HRCT. Fifty ears total, from 25 patients, had bilateral otosclerosis. The mean AC of all the ears was 63 dB, mean BC was 35.2 dB, and mean ABG was 27.8 dB. HRCT staging indicated 22 ears had Grade 1, 21 ears had Grade 2, and 7 ears had Grade 3 lesions. There was a statistically significant difference between the mean AC, BC of ears with Grade 1 and Grade 2 when compared with the mean AC, BC of ears with Grade 3. When comparing the densitometric measurements of fissula ante fenestram localizations, a statistically significant difference was observed. HRCT examination and densitometric measurements in otosclerotic patients with mixed hearing loss presented significant results. We were unable to show a significant relationship between early stage and hearing thresholds, but there was a significant relationship in advanced stage. Densitometric measurements may provide significant results for otosclerosis, particularly for the FAF region when comparing with control group.

High and dehiscent jugular bulb: clear and present danger during middle ear surgery.

PURPOSE: Internal jugular vein is anatomic continuation of cranial dural sinuses in the neck region. During the course of skull base the first enlarged segment of jugular vein is described as jugular bulb. The aim of this study is to evaluate the jugular bulb abnormalities and define the risk of high and dehiscent jugular bulb injury during middle ear surgery. METHODS: This is a retrospective radiologic study of 1,010 patients (2,020 temporal bones) with various ear symptoms who had high resolution temporal bone computed tomography scans between 2007 and 2011. RESULTS: High jugular bulb was seen in 308 (15.2 %) temporal bones. Jugular bulb dehiscence was encountered in 153 (7.5 %) temporal bones. High jugular bulb and jugular bulb dehiscence were more common in the right ears and females. Forty-one (2 %) temporal bones revealed high and dehiscent jugular bulb which can be vulnerable during middle ear surgery. High and dehiscent jugular bulb was more common in the right ears and males. Male predominance becomes more significant in the left ears. Of the 308 temporal bones with high jugular bulb, 87 (28.2 %) also had coexisting carotid canal dehiscence. CONCLUSION: High and dehiscent jugular bulb is an important anatomic variation that can result in catastrophic outcomes during middle ear surgery. Our series show that 2 % of patients can be considered in the "high-risk" group. Precise assessment of the preoperative computed tomography scans by both the radiologist and the ENT surgeon is of utmost importance. Preoperative awareness will minimize morbidity and mortality.

Extranasopharyngeal angiofibroma of the posterior nasal septum: a rare clinical entity.

Angiofibroma of extranasopharyngeal origin is very rare. Although it is usually originated from any mucosal structure in the head and neck region, maxilla is the most common involvement site. The nasal septum is an exceptional anatomic site of an angiofibroma. Surgery is the best treatment modality and recurrence is very rare. Nasal septal angiofibromas must be considered in the differential diagnosis of nasal vascular masses arising from the nasal septum. In this article, we report a 37-year-old male case with nasal septal angiofibroma who underwent surgical resection of the tumor. This is the 16th case in the literature.

Semicircular canal dehiscence: frequency and distribution on temporal bone CT and its relationship with the clinical outcomes.

PURPOSE: In this study, we aimed to investigate the frequency of SCD and its distribution and relationship with clinical outcomes on thin-section CT of the temporal bone. MATERIALS AND METHODS: Digital temporal bone CT images of 850 consecutive patients (1700 temporal bone CTs, 5100 SCs) who presented with a range of complaints such as vertigo, deafness, ear pain, fullness, and discharge between January 2008 and December 2011 were re-evaluated. Axial and oblique coronal reconstruction images of the temporal bone were made with a reconstruction thickness of 0.5mm. Additionally, superior SC was evaluated in two perpendicular planes. RESULTS: Out of 850 patients, 70 had completely normal temporal bone CT. Ninety-three patients had at least one SCD. In the temporal bone-based evaluation, 119 (26 bilateral, 67 unilateral) of 1700 temporal bones (7%) showed dehiscence. The SC-based evaluation revealed 125 SCD (2.5%) in 5100 SCs. The total number and rates of SCD were as follows: superior 103 (82.4%), posterior 13 (10.4%), and lateral nine (7.2%). Twenty of the 93 patients with SCD (21.5%) revealed no other findings on their temporal bone CTs. We determined a significant correlation between vestibular complaints, conductive hearing loss and SCD but there was no correlation between mixed, sensorineural hearing loss and SCD. CONCLUSION: We determined the frequency of SCD in 11% of patients and 7% of temporal bones. With regards to the distribution, the superior SC showed the highest dehiscence rate (82.4%). We found a significant correlation between vestibular symptoms, conductive hearing loss and SCD.

Impact of laryngopharyngeal and gastroesophageal reflux on asthma control in children.

OBJECTIVE: A prospective study was carried out to determine the sensitivity and specificity of reflux symptoms and laryngeal findings to diagnose laryngopharyngeal reflux (LPR) and gastro-esophageal reflux (GER) in children with asthma by comparing the results of double probe pH monitorization and to determine the difference between controlled and uncontrolled asthma in terms of GER and LPR coexistence. METHODS: A total of 50 patients (23 girls, mean age 10.8±0.4 years) with mild to moderate persistent asthma were included in this study. The patients were divided in two groups according to the asthma control status as controlled (n=27) vs. uncontrolled asthma (n=23). All patients completed the reflux symptom questionnaire and then they underwent flexible fiberoptic laryngoscopy and 24h double probe (pharyngeal and esophageal) pH monitorization. Laryngopharyngeal and gastroesophageal reflux were defined according to the double probe pH meter results. RESULTS: The prevalences of LPR and GER were 70% and 46% in asthmatic patients, respectively. The reflux symptom score and LPR disease index were not useful to predict LPR or GER. There was no association between asthma control status and LPR and GER. Vocal nodule seems to be a valuable sign to evaluate LPR in asthmatic children. CONCLUSIONS: The reflux symptom score and LPR disease index do not seem reliable to diagnose LPR and GER in children with asthma. The frequency of LPR and GER are independent of asthma control, atopy and long acting beta agonist usage.

Is it really necessary to delay intranasal steroid treatment after FESS? An animal study.

OBJECTIVES: The aim of this study is to investigate the effect of early intranasal steroid administration on wound healing after sinus surgery. STUDY DESIGN: Randomized, placebo-controlled, blinded animal study. SETTING: Animal laboratory. SUBJECTS AND METHODS: Forty-two male New Zealand rabbits underwent bilateral 3-mm punch resection of the concha nasalis ventralis. The animals were divided into 3 groups: saline, late steroid, and early steroid. The saline group received saline drops, the late steroid group received saline drops for 7 days followed by intranasal mometasone furoate 50 µg/nostril/d, and the early steroid group received intranasal mometasone furoate (same dose) starting on postoperative day 1. The animals were sacrificed on postoperative days 10 and 21. Left nasal specimens were examined histopathologically with hematoxylin-eosin and matrix metalloproteinase-9 (MMP-9) stains. Right nasal specimens were examined with high-performance liquid chromatography, and hydroxyproline levels were measured as mg/g in wet tissue. RESULTS: Late steroid and early steroid groups were similar with regard to MMP-9 staining on days 10 and 21. On day 10, the early steroid group revealed significantly intense MMP-9 staining when compared with the saline group, and the late steroid and early steroid groups revealed significant fibrosis when compared with the saline group. Hydroxyproline levels were similar in all groups on day 10. The early steroid group revealed significantly higher hydroxyproline levels when compared with the late steroid group on day 21. CONCLUSION: Our findings showed that early intranasal steroid administration after sinus surgery in an animal model has no detrimental effects with regard to wound-healing parameters.

Pediatric tracheotomy: 3-year experience at a tertiary care center with 54 children.

The aim of this study was to evaluate the indications, complications and outcomes of pediatric tracheotomies at a tertiary care center. Data were obtained retrospectively from 54 patients who underwent tracheotomy from July 2007 to May 2010. Over the three-year period, 54 tracheotomies were performed. Thirty-two patients (59.3%) were male and 22 (40.7%) were female. The mean and median ages of the patients were 54 and 14 months (6 days-17 years), respectively. Twenty-six patients (48.1%) were under 1 year of age. The most common indication for tracheotomy was prolonged intubation (87%), followed by upper airway obstruction (13%). Five patients (9.2%) underwent tracheotomy under semiurgent settings. The overall complication rate was 29.6% (16/54). Early complications occurred in 7 patients (13%), including accidental decannulation in 2 patients, subcutaneous emphysema in 4 patients and hemorrhage in 1 patient. Late complications occurred in 9 patients (16.7%) (stomal granulation in 7 patients and stomal infection in 2 patients). Eight patients (14.8%) were decannulated successfully. No tracheotomy-related deaths occurred, with an overall mortality rate of 27.7% (15/54). Pediatric tracheotomy is a relatively safe procedure with a low incidence of procedure-related morbidities. The indication for the majority of the procedures was prolonged intubation (87%). The lower decannulation rate is related to the higher percentage of patients needing assisted ventilation and the relatively short follow-up period.

Tympanic membrane cholesteatoma: a rare finding.

We report a rare finding of tympanic membrane cholesteatoma in a two-year-old girl. Tympanic membrane cholesteatoma without trauma or surgery to the ear is a rare entity, with few cases documented in the literature. The exact etiology of this lesion is still unclear. The presentation, clinical course and management are discussed. A whitish spot on the tympanic membrane should raise suspicion for cholesteatoma. Early diagnosis and treatment are imperative to allow an easy removal and avoid middle ear involvement.

Rhinolithiasis: an unusual cause of sinusitis complicated with frontal osteomyelitis and epidural abscess.

Rhinoliths are rare foreign bodies of the nose formed by in situ mineralization of endogenous or exogenous foreign material. They are often asymptomatic but may have various clinical presentations, with purulent rhinorrhea and nasal obstruction being the most common. They may go unnoticed for a long period and be diagnosed accidentally during a routine examination. We report a 6.5-year-old girl with rhinolithiasis complicated with sinusitis, frontal osteomyelitis and epidural abscess; she had a history dating back four years.

Poor prognostic clinicopathologic features correlate with VEGF expression but not with PTEN expression in squamous cell carcinoma of the larynx.

UNLABELLED: The aim of this study was to assess the relationship between expression of vascular endothelial growth factor (VEGF) and phosphatase and tensin homolog deleted in chromosome ten (PTEN), angiogenesis and clinicopathological parameters of squamous cell carcinoma of the larynx. METHODS: We examined immunohistochemical expression of VEGF and PTEN and CD34 for microvessel density (MVD) in sections of formalin-fixed, paraffin embedded tissue blocks of 140 patients with squamous cell carcinoma of the larynx. The intensity of VEGF and PTEN staining and the proportion of cells staining were scored. RESULTS: The tumor grade was not significantly related to PTEN expression, but it was to VEGF expression (p = 0.400; p = 0.015, respectively). While there was no significant relationship between PTEN expression and tumor size and cartilage invasion (p = 0.311, p = 0.128), there was a significant relationship between the severity of VEGF expression and tumor size (p = 0.006) and lymph node metastasis (p = 0.048) but not cartilage invasion (p = 0.129). MVD was significantly higher in high-grade tumors (p = 0.003) but had no significant relationship between MVD, lymph node metastasis, and cartilage invasion (p = 0.815, p = 0.204). There was also no significant relationship between PTEN and VEGF expression (p = 0.161) and between PTEN and VEGF expression and the MVD (p = 0.120 and p = 0.175, respectively). CONCLUSIONS: Increased VEGF expression may play an important role in the outcome of squamous cell carcinoma of the larynx. PTEN expression was not related to VEGF expression and clinicopathological features of squamous cell carcinoma of the larynx.

Changes in IGF-I, IGFBP-3 and ghrelin levels after adenotonsillectomy in children with sleep disordered breathing.

OBJECTIVE: The aim of this study was to determine the changes in insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-3 (IGFBP-3) and ghrelin levels following adenotonsillectomy (T&A) in children with sleep disordered breathing (SDB). METHODS: Forty children (mean age 4.85+/-2.15 years) clinically diagnosed with adenotonsillar hypertrophy (ATH) related SDB were enrolled. All children underwent T&A. Serum levels of IGF-I, IGFBP-3 and ghrelin were measured before and 6 months after T&A. RESULTS: Serum levels of IGF-I and IGFBP-3 were significantly higher after T&A (p<0.001). Serum ghrelin levels showed a significant decrease after T&A (p<0.001). CONCLUSION: Children with ATH related SDB who underwent T&A showed significant increases in IGF-I and IGFBP-3 levels indicating an increase in diurnal growth hormone secretion as well as a significant decrese in ghrelin levels indicating an increased oral food intake in the postoperative period.

Immune thrombocytopenic purpura-related hemotympanum presenting with hearing loss.

A 5-year-old boy was admitted to our center with a major complaint of bilateral hearing loss for 2 days. He was diagnosed with acute immune thrombocytopenic purpura 3 months before the admission and treated with high-dose methylprednisolone 2 months ago. Physical examination revealed wet purpura in the oral mucosa, serous nasal discharge, multiple petechiae and ecchymosis of the lower lip. Otomicroscopic ear examination revealed the presence of bilateral hemotympanum. The patient denied head trauma, ear pain, fever, hypertension and medications, including salicylates. The patient received high-dose intravenous methylprednisolone because of low platelet count and wet purpura for 7 days and oral prophylactic amoxicillin-clavulanate for 14 days. The onset of the response to corticosteroids was rapid, and significant hematologic improvement was observed within a few days. The 2-week follow-up examination revealed intact tympanic membranes with normal color and mobility, and the patient restored normal hearing. In this patient, hemotympanum developed rapidly, and no predisposing cause other than immune thrombocytopenic purpura was found. However, presence of a serous nasal discharge may be a sign of viral upper respiratory tract infection. Therefore, it can be speculated that sneezing or coughing might have caused bilateral hemotympanum by increasing the middle ear pressure abruptly. We would like to emphasize that bleeding may occur in unusual sites and, unlike in healthy people, may cause bizarre symptoms in patients with bleeding diathesis. Hemotympanum can be considered among the indications to start treatment in patients with acute immune thrombocytopenic purpura.