The importance of the first three days and other diagnostic indicators in sudden hearing loss.

OBJECTIVES: This study aims to compare different therapy methods used for sudden sensorineural hearing losses, to determine the prognostic factors and particularly to investigate the importance of starting the therapy within the first three days of the prognosis. PATIENTS AND METHODS: Between January 1995 and December 2008, the files of 213 patients who were treated in our clinic were reviewed. A total of 155 patients who met the inclusion criteria were included in the study. The study groups were classified according to the prognostic and audiometric factors. RESULTS: With regard to the effectiveness of treatment options, post-treatment audiometric improvement was significantly better in the patients treated with carbogen in addition to the medical therapy compared to the other groups (p=0.018). In terms of the patient characteristics at the time of admission, having vertigo, presence of a descending type audiogram curve and severe hearing loss affected the success of treatment negatively, while mild hearing loss and presence of an ascending type audiogram curve had a positive effect. The recovery rate was higher in patients who were admitted within the first three days (p=0.005). CONCLUSION: It was found that starting the therapy within the first three days and adding the carbogen to the conventional medical treatment may improve the outcome of the treatment.

The role of selective neck dissection in pathological N1 squamous cell carcinomas of the head and neck.

OBJECTIVES: This study aims to evaluate the effectiveness of selective neck dissection (SND) in stage pN1 head and neck cancers. PATIENTS AND METHODS: Patients who underwent neck dissection due to squamous cell carcinoma of oral cavity, larynx, oro-hypopharynx were evaluated retrospectively. Sixty-one patients diagnosed with pathological N1 by neck dissection were included in the study. Thirty-four of the 61 necks, to which SND was applied, comprised the study group, and 27 necks, which underwent comprehensive neck dissection (CND), comprised the control group. RESULTS: Neck recurrence rates were 4.9% for all cases, 5.9% for the SND group and 3.7% for the CND group. Two- and five-year disease-specific survival rates were similar for SND group (78.6%, 72.5%) and CND group (90.5%, 82.9%). Two- and five-year overall survival rates were also similar for SND group (67.6%, 58%) and CND group (81.5%, 66%). None of them were significantly different between groups (p>0.05). CONCLUSION: Selective neck dissection provides comparable results to CND in the treatment of pN1 necks.

Unexpected findings in the neck dissection specimens for primary head and neck squamous cell carcinoma.

OBJECTIVES: We aimed to determine the incidence of unexpected pathological findings observed during the histopathological examination of the neck dissection specimens performed for primary head and neck squamous cell carcinoma, and their impacts on the treatment and follow-up plans. PATIENTS AND METHODS: We retrospectively reviewed 410 patients (369 males, 41 females; 169 patients unilateral, 241 patients bilateral) with a diagnosis of squamous cell carcinoma of head and neck, who underwent 651 neck dissections. RESULTS: Unexpected pathological findings were found in 3.2% of patients and 2% of neck dissections. These unexpected findings were tuberculosis in eight patients (2%), metastatic papillary thyroid carcinoma in three patients (0.7%), Warthin,s tumor in one patient and cystic hygroma in one patient. All patients who had metastatic papillary thyroid carcinoma received radioactive iodine treatment after thyroidectomy. In control examinations, none of these cases had problem related to neither primary disease nor thyroid pathology. Only two of eight patients who had tuberculosis in lymph nodes received medical treatment for tuberculosis, while the others were observed by clinical and radiological examinations. None of these patients had problems related to tuberculosis. We had no long-term follow-up results for cystic hygroma and Warthin,s tumor since these patients did not continue their routine examinations. CONCLUSION: During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. Most frequently seen unexpected findings were tuberculosis lymphadenitis and metastatic papillary thyroid carcinoma. However, these pathologic findings do not seem to affect the management of the primary disease.

Hypothyroidism after primary surgical treatment for laryngeal and hypopharyngeal cancer.

OBJECTIVES: We investigated the incidence of hypothyroidism after treatment of laryngeal or hypopharyngeal cancer (LHC), and evaluated its relationship with treatment modalities. PATIENTS AND METHODS: Thyroid functions of 42 patients (41 males, 1 female; mean age 58 years; range 35 to 81 years) undergoing surgical treatment with (74%) or without adjuvant radiotherapy for LHC were prospectively evaluated preoperatively, on the 15th day, and in the sixth month postoperatively. The results were compared in relation to the treatment methods employed. RESULTS: The overall incidence of post-treatment hypothyroidism was 23.8%. Five patients had hypothyroidism in the early postoperative period, and this number increased to 10 after six months. All patients with hypothyroidism had undergone total laryngectomy with bilateral neck dissection, followed by radiotherapy. A significantly higher incidence of hypothyroidism was associated with total laryngectomy, bilateral neck dissection, level VI dissection, partial or bilateral thyroidectomy, adjuvant radiotherapy, and upper mediastinal radiotherapy. CONCLUSION: The incidence of post-treatment hypothyroidism is not rare in LHC patients, requiring long-term monitoring of thyroid functions to prevent associated morbidities.

Shoulder function after accessory nerve-sparing neck dissections.

BACKGROUND: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. METHODS: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. RESULTS: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. CONCLUSIONS: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.

Basaloid squamous cell carcinoma of the larynx: a report of four new cases.

OBJECTIVES: This study is designed to report the clinical and pathologic features and outcome of cases of basaloid squamous cell carcinoma (BSCC) of the larynx treated in our clinic. STUDY DESIGN: A retrospective review of the medical records of these patients. METHODS: Four cases of BSCC of the larynx were treated in our department. Histopathologic slides were reevaluated to confirm the diagnosis. Immunohistochemical studies were performed, and file records were reviewed. Follow-up was available for all patients and ranged between 11 and 72 (mean 37) months. RESULTS: All patients were male (mean 57), with supraglottic or transglottic larynx tumors. Two patients presented with stage-II disease and the other 2 with stage-IV disease. Initial diagnosis was invasive squamous cell carcinoma in 3 patients and BSCC in one patient. Two patients who had stage-II disease underwent partial laryngectomy and bilateral neck dissections; total laryngectomy and bilateral neck dissections were performed in stage-IV patients. Three patients received adjuvant postoperative radiotherapy, and 2 of them also received additional chemotherapy. Patients with stage-IV disease were found to have 4 and 27 metastatic lymph nodes on histopathologic examination and died because of distant metastases at 11 and 14 months, respectively. Patients with stage-II disease did not have cervical metastasis on histopathologic examination and were alive and free of disease at 52 and 72 months respectively. CONCLUSION: In contrast with the literature reporting the tendency of more aggressive clinical behavior of the BSCC, we can say that BSCC has a behavior similar to conventional squamous cell carcinoma based on our 4 cases.

[The management of pharyngocutaneous fistulas after total laryngectomy and the factors affecting their incidence]. / Total larenjektomi sonrasi farengokutanöz fistül gelisimini etkileyen faktörler ve fistül tedavisine yaklasimimiz.

OBJECTIVES: This study sought to determine the incidence and etiologic factors of pharyngocutaneous fistulas occurring after total laryngectomy. PATIENTS AND METHODS: A total of 138 patients (136 males, 2 females; mean age 59.5 years; range 36 to 83 years) underwent total laryngectomy for squamous cell carcinoma. Risk factors and the management of pharyngocutaneous fistulas were assessed together with durations in relation to fistula occurrence, oral feeding, hospitalization, and healing. RESULTS: Pharyngocutaneous fistulas were seen in 37 patients (26.8%). Significantly high rates of fistula occurrence were detected in patients with alcohol consumption (p=0.032), and in those who underwent partial pharyngectomy (p=0.058) or bilateral neck dissection (p=0.049) along with total laryngectomy. The occurrence of fistulas was significantly associated with prolonged lengths of time for oral feeding and hospital stay (p<0.001). Fistulas were repaired surgically in 24.3% of patients, in whom the time to oral feeding was significantly shorter than that of patients who received local wound care (p=0.03). CONCLUSION: Our data show that early surgical intervention is more beneficial in preventing further morbidity associated with pharyngocutaneous fistulas.

[The incidence of hyperinsulinemia in patients with tinnitus and the effect of a diabetic diet on tinnitus]. / Tinnituslu hastalarda hiperinsülinemi sikligi ve diyabet diyetinin tinnitus üzerine etkisi.

OBJECTIVES: We investigated the incidence of hyperinsulinemia in patients presenting with tinnitus and evaluated the effect of diabetic diet on tinnitus. PATIENTS AND METHODS: Serum insulin levels were measured and oral glucose tolerance test was performed in 52 patients (26 males, 26 females; mean age 50 years; range 20 to 80 years) with idiopathic tinnitus. Those with hyperinsulinemia were given a diabetic diet for four months. A questionnaire was administered to all the patients and the complaint of tinnitus was assessed according to a rating scale before and after treatment. The results were compared with those of 15 age-and sex-matched controls. RESULTS: Hyperinsulinemia was detected in 76% and 27% of the patients and the controls, respectively (p<0.05). Oral glucose tolerance test was normal in 48% of the patients, and in 80% of the controls (p<0.05). Following a diabetic diet, the severity of tinnitus complaints significantly decreased in patients with hyperinsulinemia (p<0.0001). CONCLUSION: Hyperinsulinemia may play an etiologic role in tinnitus and a diabetic diet may result in significant improvement in tinnitus complaints in this population.

[ENT examination in SCUBA divers and ENT pathologies restricting diving]. / SCUBA dalicilarinda KBB muayenesi ve dalisa engel KBB patolojileri.

SCUBA diving can be safely performed if a careful pre-dive examination regarding the medical standards of diving is performed, and if all necessary precautions are taken with attention being paid to the potential risks of diving. The most frequent medical problems arising from SCUBA diving fall into the otolaryngology discipline; thus, candidates should be examined in terms of ENT disorders that may prevent them from diving. This article aims to review particular aspects of ENT examination, investigation methods, and criteria for candidates