Surgical management of cervical oesophageal cancer.

OBJECTIVE: Cervical oesophageal cancer is a difficult problem to manage. The aim of this study was to report our experiences with the surgical treatment of cervical oesophageal cancer and the oncological results obtained in our patients. METHODS: Nineteen patients with cervical oesophageal cancer underwent surgical treatment between January 2001 and February 2011. Eighteen patients underwent pharyngolaryngoesophagectomy and one patient underwent pharyngoesophagectomy. Reconstruction of the digestive tract with gastric transpositions was performed in 18 patients and right colon transposition was performed in one patient. RESULTS: No operative mortality was noted. Significant complications occurred in nine patients. The distant metastasis rate was 47%. Overall three- and five-year survival rates were 30% and 28%, respectively and the three- and five-year disease-specific survival rates were 41% and 39%, respectively. CONCLUSION: Pharyngolaryngoesophagectomy with gastric transposition can be performed for the treatment of cervical oesophageal cancer. However, despite radical resection and adjuvant therapy, survival rates are low.

Effects of systemic steroids on life quality in sinonasal polyposis.

OBJECTIVE: To determine the effectiveness of short-term glucocorticoid therapy on nasal polyposis. METHODOLOGY: A total of 60 patients with sinonasal polyposis were given oral glucocorticoid therapy (1 mg/kg) for 20 days. Patient symptoms were evaluated with the Sino-Nasal Outcome Test 20 (SNOT-20). Computerized tomography (CT) images of the paranasal sinus were acquired before and after treatment and were evaluated with the Kennedy scoring system. RESULTS: Evaluation of paranasal CTs showed complete disease resolution in 15 patients and partial disease resolution in 25 patients. Patients with complete and partial resolutions,based on CT images, exhibited significant decreases in disease stages. Statistical analysis revealed a significant change in the SNOT-20 results (P < 0.01). There were no statistically significant differences among the evaluations based on the paranasal sinus CTs, the SNOT-20, and the SNOT-20 combined with a subjective selection of the five most disturbing symptoms (SNOT-20(+5)) (P > 0.05). CONCLUSION: The results showed a strong correlation between radiological changes and improvements in quality of life, assessed with the SNOT-20 or the SNOT-20(+5).

Submandibular hydatid cyst fistulized into the oral cavity.

UNLABELLED: Hydatid cysts of the head and neck are rare, even in regions where echinococcal infestation is endemic. Although complications, like cyst rupture and infection, may occur, an external fistula is extremely rare. This study examined a case of hydatid cyst that had fistulized in the right submandibular region of the oral cavity, which eroded the mandible. CASE REPORT: A 45 year-old female patient visited our clinic with complaints of a discharge that left a bad taste in her mouth that persisted for 1 month and a painless swelling in the right submandibular region that had slowly expanded over the past 5 months. A physical examination revealed a cystic mass located in the right submandibular region that had fistulized in the oral cavity. The results were consistent with a hydatid cyst. We performed submandibular gland exeresis and a marginal mandibulectomy to excise the hydatid cyst together with the fistulous tract.

Vitamin B12 levels in patients with tinnitus and effectiveness of vitamin B12 treatment on hearing threshold and tinnitus.

OBJECTIVES: The aim of this study was to determine vitamin B12 levels in patients with non-pulsatile tinnitus and to assess the efficacy of replacement treatment in tinnitus and hearing in patients with vitamin B12 deficiency. MATERIALS AND METHODS: We assessed 100 patients (mean age, 43.87, SD 10.12; 62 females, 38 males) and 20 healthy volunteers (9 females, 11 males). Patients whose blood serum vitamin B12 levels were below 180 pg/mL were deemed to be vitamin B12-deficient. The effect of vitamin B12 replacement treatment on hearing was examined using audiometric tests between 250 and 20000 Hz, and we compared results with a visual analogue scale (VAS) before and after treatment, which helped to produce an objective assessment of the therapeutic results in tinnitus. RESULTS: Tinnitus was found to be unilateral in 57% of cases (the right ear in 56% and the left ear in 44% of these cases) and bilateral in 43% of cases. Of the patients with tinnitus, 63 had low B12 vitamin levels, and 37 had normal B12 vitamin levels. No statistically significant difference was found with the control group levels (p = 0.80, odds ratio = 1.13). No significant change was observed in tinnitus severity after vitamin B12 therapy. Eight of these patients reported some relief in tinnitus on the VAS, but the rate of improvement was not significant (p > 0.05). In the tinnitus patients with low B12 vitamin levels, audiometric tests conducted after B12 vitamin treatment revealed a significant improvement in hearing levels only at the 250 Hz frequency. No change was observed at other frequencies. CONCLUSION: B12 replacement treatment was not effective in these patients with tinnitus. Some patients improved following vitamin B12 supplementation but the results were not significant. More studies are needed to find the reasons for, and effective treatment of, tinnitus since the aetiology of subjective tinnitus is highly variable.

Horizontal glottectomy: oncological results.

OBJECTIVE: The aim of this study was to assess the oncological results of patients after horizontal glottectomy. METHODS: A cohort of 35 patients (34 males and 1 female, mean age 59.2 years) who underwent a horizontal glottectomy between June 2001 and June 2010 was analysed retrospectively. The mean follow-up period was 77.9 +/- 28.1 months. The Kaplan-Meier method was used to analyse overall survival and disease-specific survival. RESULTS: All of the patients were decannulated and put on a normal diet following nasogastric feeding tube removal. The overall survival rates at 3 and 5 years were 97 and 93% respectively. The 3- and 5-year disease-specific survival rates were 100 and 97% respectively. There were 2 local recurrences (5.7%), 1 distant metastasis (2.8%), and 2 second primary tumours (5.7%). CONCLUSION: Horizontal glottectomy is an oncologically safe technique in properly selected patients with glottic tumours.

Does the stapes reflex remain the same after Bell's palsy?

OBJECTIVE: The authors investigated the integrity and function of nervus stapedius 1 year after facial paralysis. STUDY DESIGN: Patients with Bell's palsy were observed prospectively for 1 year and compared with healthy patients. SETTING: The follow-up of patients was done in the outpatient clinic and tests were applied in the audiology unit. PATIENTS: The mean age of 32 patients was 41.03 years. Eight of 32 patients were grade II (25%), 11 were grade III (35%), and 13 were grade IV (40%) according to House-Brackman grading system. The mean age of the control group (10 persons) was 36.5 years. INTERVENTION: Contralateral stimulus was used in acoustic reflex test at 500 and 1,000 Hz with 80-, 90-, 100-, and 110-dB stimulus intensity. Tests were applied in three ways: normal position, eye-closed position, and grin position. Tests were done in the first 15 days of facial paralysis and repeated at least 1 year thereafter. The millimeter difference in amplitude of impedance recording of middle ear between the normal ear and paralyzed ear was accepted as criterion. MAIN OUTCOME MEASURES: There were 6- to 9-mm amplitude differences between normal side and healed side of grade IV patients with 100- and 110-dB stimuli. RESULTS: In the second test (after 1 year), statistically significant differences were present between control group and grade IV patients on 1,000 and 500 Hz frequencies with 100- and 110-dB stimulus intensity (p < 0.05). There were no significant differences between grade II and control group and between grade III and control group. CONCLUSIONS: A permanent partial denervation is present on the stapedial nerve, especially after grade IV paralysis, and it affects the function of stapes muscle in high decibel sounds. But it does not affect the stapes reflex threshold. No synkinetic innervation was found in the authors' patient group with their test method.