The protective effects of different treatments on rat salivary glands after radiotherapy.

This study was aimed to evaluate the efficacy of treatment modalities for minimizing salivary gland damage caused by radiotherapy. Forty rats were divided into five groups. Group 1 had no irradiation or any treatment. Group 2 underwent only 15 Gy single dose radiotherapy. N-acetylcysteine, dexamethasone, hyperbaric oxygen treatment were given, respectively to the group 3, 4 and 5 for 5 days. 15 Gy single dose radiotherapy was applied to the group 3, 4 and 5 on the second day. Pyknosis, lysis, and vacuolization were examined in ductal cells and pyknosis, lysis, vacuolization, inflammation and collective duct damage in acinar cells. Dexamethasone and hyperbaric oxygen did not prove to have a positive effect on acinar and ductal cell. N-acetylcysteine-applied group had statistically significantly lower amount of damage. We determined that the decrease of ductal and acinar cell damage in parotid glands of N-acetylcysteine-applied rats was more distinct and statistically.

Interesting association of squamous cell carcinoma of soft palate and tuberculous lymphadenitis.

Squamous cell carcinoma is the most common malignancy of the soft palate. In some cases, it mimics mycobacterial infections and in others it can develop against the background of a previous tuberculosis infection. Here we report a case of a 68-year-old male who presented with squamous cell carcinoma of the soft palate. He had metastatic lymphadenopathy on the right side and, simultaneously, two caseating granulomatous lymphadenopathies without metastatic lymph nodes on the left side. The patient was treated with soft palate excision and bilateral functional neck dissection. Standard antitubercular therapy and radiotherapy were added postoperatively. To our knowledge this is the first case in the English-language medical literature of a head and neck cancer in the setting of tuberculosis. Tuberculosis may mimic head and neck cancers and vice versa, and both conditions may have atypical clinical and radiological presentations. Our case points out the need to consider tuberculosis in the differential diagnosis of squamous cell carcinoma of the head and neck.

Efficiency of hyperbaric oxygen and steroid therapy in treatment of hearing loss following acoustic trauma.

INTRODUCTION: Most commonly used treatment modalities for acute acoustic trauma (AAT) include steroid and hyperbaric oxygen (HBO2) therapy. The aim of this study is to investigate the effectiveness of combined steroid and HBO2 therapy in patients who develop AAT during firearms training and the effect of delay to treatment on treatment success. MATERIALS AND METHODS: Patients admitted with the complaint of hearing loss after firearms training between January 2011 and April 2013 were evaluated retrospectively. Patients were grouped according to date of admission; patients admitted within the first 10 days were included in Group A and those admitted between Days 11 and 30 in Group B. RESULTS: A total of 48 patients (73 ears) with AAT were included. There were 37 ears in Group A and 36 ears in Group B. The number of ears with complete treatment response, partial treatment response and treatment failure (unchanged) were one (2.7%), 7 (18.9%) and 29 (78.4%) in Group A and 0 (0%), 3 (8.3%) and 33 (91.7%) in Group B, respectively. There was no statistically significant difference between the groups (p = 0.095). Late-term results (at Week 6) demonstrated Group A showed higher hearing gain on high frequencies than Group B (p < 0.05), but this result was not consistent with clinical outcome results. CONCLUSION: The success rate of combined HBO2 and steroid therapy was very low in our study. However, early initiation of treatment results in better outcomes. Protective measures have great importance in preventing AAT.

Hydroxyproline levels in nasal polyps.

The aim of this study was to evaluate hydroxyproline levels in nasal specimens from patients with nasal polyps, and to examine hydroxyproline levels after nasal steroid spray and oral steroid treatments. This study was performed on 41 patients. The subjects were divided into four groups: no medication group (group A, n 11), oral methylprednisolone group (group B, n 8), topical steroid spray group (group C, n 8) and control group (group D, n 14). Nasal polyp samples were collected endoscopically. Healthy subjects were studied as a control group, and their nasal samples were taken during turbine reduction surgery. All samples were analyzed using the immunocytochemistry method. Hydroxyproline levels were investigated and compared with the control group. Mean hydroxyproline levels in groups A-D were 98.48, 24.20, 8.97 and 4.52, respectively. The hydroxyproline levels were significantly higher in group A compared with that of group D. The treatment that revealed significant decreases in hydroxyproline levels was group C. Although there was also a noticeable reduction in group B, there were no statistically significant differences between group B and group A. Our study revealed a significant correlation between nasal polyp and hydroxyproline levels. The hydroxyproline levels were significantly higher in nasal polyps. Both oral and topical steroid treatments decrease hydroxyproline levels in nasal polyps. Thus, in theory, steroid treatment can directly decrease hydroxyproline levels by inhibiting proline hydroxylase and indirectly by lowering the inflammatory process.

Efficacy of topical halofuginone in myringotomy patency.

The objective of the study is to determine whether topical halofuginone (HF) application has an impact on prolonging the time for healing of myringotomy incision, and to investigate histopathologic effects of HF on tympanic membrane (TM) in rat model. Forty rats with normal eardrums were involved in this study. The study group and control group consisted of 30 and 10 rats, respectively. A posterior incision 1 mm in diameter was made on healthy eardrums of the rats. Following incision, gelfoam soaked with HF hydrobromide of 30 mg/dl was applied on the perforation in study group, whereas gelfoam soaked with isotonic saline was applied on the perforation in control group. On days 1, 3, 7, 10, 14, 18, 21, 24, 27, and 30, otoendoscopic evaluation of eardrums under general anesthesia was conducted and perforations were screened. A rat of each group was killed in control days and TMs were dissected to evaluate histopathological changes. The average times for patency of perforation in study and control groups were 21.43 and 7.50 days, respectively. The difference was found to be statistically significant (p < 0.05). Histopathological evaluation revealed that HF reduces hyalinisation and fibrosis in eardrum, when compared with the control group. In conclusion, HF significantly delays closure time of myringotomies in rat model. However, this delay may not be enough for recovery of otitis media with effusion.

[Prevalence of chronic otitis media in the young male population in Turkey]. / Türkiye'de genç erkek nüfusunda kronik otitis media prevalansi

OBJECTIVES: In this study, we investigate the prevalence of chronic otitis media (COM) in young men. PATIENTS AND METHODS: Twenty thousand consecutive young men (mean age 22 years) who were under election for high performance military positions were examined by two otolaryngologists in the Military Hospital, Izmir. The otologic examination findings were noted. We evaluated the patients who have tympanic membrane perforation, retraction, adhesion, myringosclerosis and the patients who had underwent surgery before. RESULTS: Three-hundred and fifty-five young men (1.77%) had COM. Other findings were retraction (n=66; 0.33%), adhesion (n=36; 0.18%), myringosclerosis (n=720; 3.6%) and cerumen (n=3200; 16%). We found out that five (0.025%) of the cases had radical mastoidectomy surgery and 16 (0.08%) of them had tympanoplasty. CONCLUSION: The prevalence of COM in young men is 1.77%. Although our study has a limitation because all of our samples are young men, the study is unique due to its large sample size.

Histologic analysis of the effects of three different support materials within rat middle ear.

OBJECTIVE: To investigate histologic changes in the mucosa of rat middle ear after implantation of three different support materials. STUDY DESIGN: A prospective, controlled animal study. SUBJECTS AND METHODS: Three types of absorbable materials were implanted into the middle ear cavity of rats: (1) Gelfoam (purified gelatin) (Pharmacia & Upjohn Company, New York, NY), (2) Sepragel (viscoelastic gel composed of cross-linked polymers of hyaluronan) (GENZYME Corp, Ridgefield, NJ), and (3) Nasopore (a biodegradable/fragmentable, synthetic polyurethane foam) (Polyganics, Groningen, The Netherlands). Rats were sacrificed after 3 and 20 days to ascertain early and late histologic changes. The bulla of each rat was excised and prepared for microscopic examination. The histologic changes were evaluated by observation of the middle ear cavity and mucosa in terms of polymorphonuclear leucocytes (PMNL), macrophages, giant cells, fibroblasts and other cells, fibrosis, and remnant materials. RESULTS: The histologic appearance of gelfoam-treated middle ears was characterized by more severe acute inflammation in the short-term and prominent fibrosis in the long-term in comparison with sepragel- and nasopore-treated groups. Nasopore appeared to be prone to remnant formation and reorganization by means of fibroblastic activity. CONCLUSION: Compared with gelfoam, both sepragel and nasopore caused less histologic alterations.

Effectiveness of topically applied halofuginone in management of subglottic stenosis in rats.

OBJECTIVE: The aim of the study is to ascertain the antifibrotic effect of topically applied halofuginone after acute subglottic injury. MATERIALS AND METHODS: After standardized trauma to subglottic area, rats were divided into two groups: the study group that received treatment and the control group that did not. The subjects were treated with topical application of cottonoid soaked in 30 mg/dL halofuginone solution for 5 minutes after subglottic trauma. The larynx specimens were examined histopathologically by light microscopy to assess fibrosis, epithelialization, inflammation, and necrosis. RESULTS: The fibrosis indexes of the treated group were significantly less than those of the control group (P < 0.05). CONCLUSIONS: Topically applied halofuginone hydrobromide decreases fibrosis/scar tissue formation secondary to experimentally induced acute subglottic trauma.

Comparison of uvulopalatopharyngoplasty and uvulopalatal flap in Turkish military personnel with primary snoring.

OBJECTIVE: To compare the surgical results of uvulopalatopharyngoplasty (UPPP) and uvulopalatal flap (UPF) procedures in the treatment of primary snoring. MATERIALS AND METHODS: Two study groups were formed and UPPP and UPF procedures were performed. All patients were stratified according to the modified Friedman staging system. Patients with tonsil size 2-4, palatal position scale grade 2, and body mass index lower than 30 were enrolled in the study. The success of surgical procedures was evaluated by applying a snoring questionnaire and Epworth sleepiness scale preoperatively and 90 days after the operation. Patients were followed for postoperative pain and other complications. RESULTS: Snoring was relieved in 85% of UPPP and in 83.3% of UPF patients 90 days after the operation. Postoperative pain complaint was more prominent in the UPPP group and mean duration of pain was significantly longer compared with the UPF group. CONCLUSIONS: Despite similar success rates in the short-term, we can say that the UPF procedure is more practical and comfortable when compared to the UPPP in the military setting.

Comparison of paper-patch, fat, and perichondrium myringoplasty in repair of small tympanic membrane perforations.

OBJECTIVE: To compare the effectiveness of paper-patch, fat, and perichondrium myringoplasty in the treatment of chronic tympanic membrane perforations smaller than 3 mm. SUBJECTS AND METHODS: This investigation included 45 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into 3 main groups according to surgical procedures. Each group consisted of 3 subgroups, which had 1-mm, 2-mm, and 3-mm perforations. The patients underwent paper-patch, fat, or perichondrium myringoplasty via transcanal approach under local anesthesia. Healing of perforation, hearing improvement, and complications were investigated. RESULTS: Closure rates of the perforations in the paper-patch, fat, and perichondrium myringoplasty groups were 66.7%, 86.7%, and 86.7%, respectively. There were no statistically significant differences in tympanic membrane closure rates between techniques with regard to size. CONCLUSION: Three techniques were found to be feasible for tympanic membrane perforations smaller than 3 mm.

[Type I Chiari malformation presenting with isolated unilateral hypoglossal nerve and vocal cord paralysis]. / Izole tek tarafli hipoglossal sinir ve vokal kord paralizisi ile ortaya çikan Chiari tip I malformasyonu.

Chiari malformation refers to caudal displacement of posterior fossa structures through the foramen magnum in the cervical canal and is classified according to the severity of displacement and accompanying cranial nerve and cervical pathologies. We presented a 24-year-old male patient who had isolated unilateral paralysis of the hypoglossal nerve and vagus nerve, with thyroid cartilage asymmetry. Chiari type I malformation was diagnosed by craniospinal magnetic resonance imaging. Suboccipital craniectomy and cervical 1-level large partial laminectomy were performed by the neurosurgery department. No improvement was observed in hypoglossal and vagal paralysis during an 18-month follow-up.

The Impact of Vitamin D Deficiency on Retinopathy and Hearing Loss among Type 2 Diabetic Patients.

AIM: The current study was aiming to investigate the relation between vitamin D, retinopathy, and hearing loss among type 2 diabetes mellitus (T2DM) patients. METHODS: Cross-sectional study carried on 638 subjects aged between 20 and 60 years who visited the Endocrinology, Ophthalmology, and ENT Outpatient Clinics of the Medipol Hospital during the period from March 2016 to May 2017. Two audiometers Grason Stadler GSI 61 and Interacoustics AC40 Clinical audiometer were used to evaluate the hearing loss. Risk factors for diabetic retinopathy were evaluated, including age, sex, diabetes duration, glycated hemoglobin (HbA1c), hypertension, and lipid profiles. RESULTS: The mean age (± SD, in years) for retinopathy with hearing loss versus normal subjects was 47.7 ±10.2 versus 48.5±9.1. The associated risk factors were significantly higher in T2DM with hearing loss, hypertension (32.6% versus 15.7%), tinnitus (40.0% versus 18.0%), vertigo (59.7% versus 26.8%), and headache (54.9% versus 45.3%), than in normal hearing diabetes. There were statistically significant differences between hearing impairment versus normal hearing for vitamin D [19.40±9.71 ng/ml versus 22.67±9.28 ng/ml; p<0.001], calcium, magnesium, phosphorous, cholesterol, HDL-C, LDL-C, albumin, systolic blood pressure [131.70±9.25 Hg versus 127.73±11.98 Hg], diastolic blood pressure [82.20±8.60 mm Hg versus 79.80±8.20 mm Hg], and microalbuminuria. Multivariate logistic regression analysis revealed that variables such as vertigo, duration of DM, mobile/I pad phone, vitamin D deficiency, sleeping disturbance, headache, frequently TV watching, tinnitus, cigarette smokers, and hypertension were considered at higher risk as a predictors of retinopathy with hearing loss among diabetic patients. CONCLUSION: Vitamin D deficiency is considered as a risk factor for diabetic retinopathy and hearing loss among diabetic patients. Meanwhile, hyperglycemia could be considered as a modifiable risk factor for diabetic retinopathy; tight glycemic control may be the most effective and important therapy for improving quality of life and substantially reducing the incidence of retinopathy and in T2DM patients.

Effects of halofuginone on fibrosis formation secondary to experimentally induced subglottic trauma.

OBJECTIVE: The aim of the study was to assess the antifibrotic effect of systemically applied halofuginone after subglottic injury. MATERIALS AND METHODS: After standardized trauma to subglottic area, rats were divided into two groups: a study group that received treatment and a control group that did not. The rats were treated with 0.1 mg/kg/day intraperitoneal halofuginone injection for 30 days. The larynx specimens were examined histopathologically under light microscope for epithelization, inflammation, necrosis, and fibrosis. RESULTS: The fibrosis indexes of the treated group were significantly less than those of the control group (P < .01). CONCLUSIONS: Systemically applied halofuginone hydrobromide decreases fibrosis/scar tissue formation secondary to experimentally induced acute subglottic trauma.

The impact of endoscopic cultures on care in rhinosinusitis.

OBJECTIVES: The objectives of this retrospective, observational study were primarily to analyze endoscopically guided culture results (EGCRs) from an office setting in patients with subclassifications of chronic rhinosinusitis (CRS) and to determine the frequency EGCR-altered patient management; and secondarily to determine whether purulent secretions are more likely to be positive for a bacterial pathogen. METHODS: Consecutive symptomatic patients with nasal secretions not currently on antibiotics were cultured endoscopically. Patients were classified as chronic rhinosinusitis (CRS; n = 41) or acute exacerbation of chronic rhinosinusitis (AECRS; n = 27). Initial therapy was individualized and 32 of 68 (47%) had an antibiotic initiated before availability of the EGCR. Patients were reassessed 2 to 4 days later, and therapy was continued or altered based on clinical course and EGCR. RESULTS: EGCRs were positive in 41 of 68 (60.2%) of all patients. Incidence of positive cultures was not statistically different between CRS (21 of 41 [51%]) and AECRS (20 of 27 [74%]) patients. Initial therapy was changed in 45 of 68 (66%) patients. In 35 of 68 (51.4%), the change was directed by EGCR; in 11 of 77 (14.2%), the change was unsubstantiated by EGCR, and in no cases was an antibiotic initiated inappropriate to EGCR. The frequency of pathogens in the subgroups of CRS and AECRS, respectively, were Staphylococcus aureus (9 of 41 [22%]; 9 of 27 [33%]), acute pathogens (6 of 41 [14.6%], 7 of 27 [25.9%]), and Pseudomonas aeruginosa (5 of 41 [12%], 5 of 27 [18.5%]) and were not statistically different between subgroups. Purulent cultures were not significantly more likely to be Gram stain-positive than nonpurulent cultures (12 of 34 [35%] compared with 6 of 34 [17.6%], respectively; P = .1). Purulent cultures were more likely to be culture-positive (25 of 34 [73.5%]) compared with nonpurulent secretions (17 of 34 [50%]; P < .05). AECRS was significantly more likely to be purulent (21 of 27 cases) compared with CRS (13 of 41 cases, P < .001). CONCLUSION: EGCR directed a change in therapy in 35 of 68 (51.4%) patients with CRS. The pathogens isolated from CRS and AECRS were similar and predominately S. aureus, acute pathogens, and P. aeruginosa. Purulent secretions are more frequently bacteriologically positive than nonpurulent secretions and more common in AECRS than CRS.

Juvenile spring eruption: a report of two cases.

Juvenile spring eruption is a photodermatosis characterized by the development of papules and vesicles on the light-exposed helix of the ears after sun exposure, usually in the springtime. It mainly affects boys and young male adults, and has a tendency to occur in the form of small epidemics. We report an outbreak in a group of soldiers who were performing military exercises during cold and sunny weather during a midwinter season. The clinicopathologic features and laboratory test results are described in two of these cases.

Histologic effects of injection snoreplasty and radiofrequency in the rat soft palate.

OBJECTIVE: This study was undertaken to compare the effects of radiofrequency and injection snoreplasty on the histological structure of the soft palate in an animal model. STUDY DESIGN AND SETTING: This is a blinded, controlled histologic evaluation of rat soft palates that underwent separate palatal interventions. Fifty rats were divided into 5 groups of 10 rats (Group 1 = injection snoreplasty [IS], Group 2 = IS + steroid, Group 3 = saline injection, Group 4 = radiofrequency ablation [RFA], and Group 5 = no intervention). The animals were sacrificed after 24 hours, 1 week, 3 weeks, and 5 weeks. Then the soft palates were subjected to histological analysis. RESULTS: Histological analysis demonstrated normal remucosalization in all specimens, with fibrosis increased in Group 1. Interstitial edema was minimal in Group 2. Keratinization was most apparent in Group 4. CONCLUSION: Radiofrequency and injection snoreplasty stiffen the rat soft palate compared with controls.

Nasal septal cyst: a case report.

Nasal septal cyst is a rare complication seen after submucous resection of the nasal septum. A 25-year-old male patient presented with a complaint of nasal obstruction four years after submucous resection. Physical examination revealed a grey mass obstructing both nasal cavities and the nasal airway. Magnetic resonance imaging showed a nasal septal cyst filling the nasal cavity. Following aspiration of the cyst content, endoscopic examination was performed and perforation of the lower part of the nasal septum was noted. Under local anesthesia, superior, posterior, and anterior parts of the cyst and the left wall of the septum were endoscopically released and prepared to be used as a flap. It was sutured on the lower part of the septal perforation. No recurrence was seen during a follow-up of 18 months.

Investigating the Effects of Smoking on Young Adult Male Voice by Using Multidimensional Methods.

OBJECTIVES: Smoking is one of the most common harmful habits in the world, especially common among young adult male population in Turkey. The purpose of this study was to evaluate the effect of smoking on the young adults' male voice using multidimensional voice assessment methods. STUDY DESIGN: This is a case-control study. METHODS: The study included 109 young adult men, 51 nonsmokers and 58 smokers between the ages of 20 and 34 years. The voice evaluation protocol consisted of voice handicap index (VHI), maximum phonation time (MPT), and perceptual, acoustic, and videostroboscopic analyses. RESULTS: A statistically significant increase for physical, physiological, and total scores of VHI was found in smokers group (P < 0.05). MPT showed significantly lower values among smokers (P < 0.05). There were no significant changes in perceptual analysis of voice samples between smoker and nonsmoker groups. There were no significant changes in any of the acoustic parameters between smoker and nonsmoker groups. Results of videostroboscopic analysis showed significant relationships between smoking and increased vocal fold erythema (P < 0.05). In addition, significantly asymmetry, amplitude, and periodicity abnormality of vocal fold movements were observed in smoker group during phonation (P < 0.05). CONCLUSIONS: The results of this study indicate that observable signs of laryngeal irritation and disturbed phonatory physiology occur even in young adults with relatively brief smoking habits. Subjective symptoms of smoking on voice appear to occur earlier than objective findings.

TRAIL and TRAIL receptors in patients with laryngeal cancer.

BACKGROUND: Tumor necrosis factor-related associated-inducing ligand (TRAIL) is a death ligand currently under clinical trials for laryngeal carcinoma. METHODS: Paraffin-embedded tissues from 40 patients with laryngeal carcinoma and 20 patients with benign laryngeal pathologies were retrospectively analyzed using immunohistochemistry in terms of distribution and intensity, and for final analysis of immunoreactivity of receptors, H-score was used. The study group was assessed in terms of localization, lymph node staging, tumor stage, overall survival, disease-free survival, locoregional control, perineural invasion, and vascular invasion. RESULTS: The H-score of decoy-R2 (DcR2) staining were increased significantly in tumor tissue (p = .04). A significantly greater increase in terms of H-score of DR5 receptor staining (p = .06) was detected in tumor tissue. CONCLUSION: TRAIL-mediated gene therapy may not be effective. Indeed, the findings may indicate treatment resistance. TRAIL and TRAIL receptor levels were not associated with prognosis © 2015 Wiley Periodicals, Inc. Head Neck 38: E535-E541, 2016.

Effects of topical application of mitomycin-C and 5-fluorouracil on myringotomy in rats.

OBJECTIVE: The effects of topical application of Mitomycin-C (MMC) and 5-fluorouracil (5-FU) for maintaining myringotomy patency were investigated in this experimental study. STUDY DESIGN: We performed simple myringotomy with a knife on 140 tympanic membranes of 70 rats. Rats were divided in two study groups and a control group. Each study group had 60 tympanic membranes, and the control group had 20. We applied Mitomycin-C (0.4 mg/ml) in Group A, 5-fluorouracil (50 mg/ml) in Group B topically, and sterile saline in the control group for 10 minutes. Examination was made with otoendoscope on days 1, 3, 5, 7, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, and 70, and patency rates were recorded. RESULTS: MMC and 5-FU Groups remained open for a mean of 46.17 days and 14.62 days, respectively. The control ears healed within 10.4 days. Fibrosis of the MMC-treated group was the same as that of 5-FU-treated groups. Fibrosis of both study groups was significantly lower than that of the control group. CONCLUSIONS: MMC is more effective than 5-FU, which is more effective than the simple myringotomy procedure in extending the patency of myringotomies in rat tympanic membranes (p < 0.05). Both medications are useful as an adjunct in preventing myringotomy closure.