Two cases of granular cell tumors of the head and neck at different sites.

Granular cell tumor (GCT) is an uncommon, primarily benign lesion. We describe 2 cases of GCT. Patient 1 was a 38-year-old man who presented with a reddish, vegetative lesion that involved the posterior third of the left true vocal fold. Patient 2 was an 18-year-old girl who presented with a firm, slightly extruded submucosal mass in the posterior lateral third of the tongue. Both lesions were identified as GCTs on biopsy. Both tumors were removed surgically, and both patients exhibited no signs of recurrence during follow-up. It is important that otolaryngologists be familiar with GCT and its management. Although the length of follow-up has varied substantially in the literature, we recommend long-term surveillance, including regular clinical examinations and periodic imaging with contrast-enhanced magnetic resonance imaging, at least until additional studies have clarified the natural history and recurrence patterns of GCT with greater certainty.

Prevalence of otitis media with effusion among primary school age-children and etiopathogenic examination.

A prevalence study was carried out in order to look into the etiopathogenic relation of otitis media with effusion (OME) in primary school-age children. The study included ENT examination and a questionnaire that was carried out in 4 randomly selected schools on 1,165 children. 143 of the cases (12.2%) had OME. A significant relation between OME and adenoid vegetation was found (P<0.01) while no significant relation between EOM and recurrent tonsillitis and allergic rhinitis was found (P>0.05). As a result, OME is a common disease that can lead to other hard-to-cure health problems and be costly if etiopathogenic factors are not resolved on time.

Effectiveness of intratympanic dexamethasone in otitis media with effusion resistant to conventional therapy.

The aim of this study was to determine the efficiency of intratympanic dexamethasone (ITD) injections as a new treatment modality in otitis media with effusion resistant to conventional therapy. We planned a nonrandomized prospective study to determine the safety and effectiveness of the direct administration of dexamethasone into middle ear cavity with chronic eustachian tube dysfunction. This study was applied on 75 ears of 64 patients aged from 12 to 60 years. ITD received 47 ears of 41 patients who had previously been treated by medical or surgical therapy middle ear effusion without resolution classified as study group. They were taken conventional medical therapy again 28 ears of 23 patients classified as a control group. ITDs were administered 0.5 ml/4 mg per mm directly in antero-superior quadrant of tympanic membrane. These injections were repeated once a week for 4 weeks. Results were evaluated by using audiometric and tympanometric measurements 1 and 3 months after the treatments. Audiometric measurement shows that 9.91 dB improvement in the mean air-bone gap 15.17 dB in air conduction (AC) pure-tone averages (PTA) and 5.25 dB bone conduction (BC) PTA. But the control group data showed only 2 dB improvement in the mean air-bone gap, 3 dB AC-PTA and 1.36 dB BC-PTA. Tympanometric improvement was found. In 28 ears of patients (59.6%) like type B or C converted to type A in study group without complication but only in three ears (10.7%) of control group. ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic eustachian tube dysfunction. No complications like tympanic membrane perforation and/or sensorineural hearing loss have occurred.

Carotid body tumors and our surgical approaches.

Glomus tumors known as paragangliomas are neoplasms arising from the neural crest. They are named according to the place they originate from. Tumors originating from the carotid body at the carotid bifurcation are called Carotid Body Tumors (CBT). Surgical intervention is planned according to the Shamblin classification. 17 patients were operated after being diagnosed with CBT in our clinic between February 2007 and June 2010. 12 (70.5%) of the patients were male, and 5 (29.4%) of the patients were female. The average age was 42 (ages ranging between 32 and 47). Nine of the patients were diagnosed and treated with Shamblin type I tumor, seven of the patients with type II and one patient with type III. Only one patient had bilateral carotid tumor. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly by means of thermal cautery in the subadventitial plane. The patient with Shamblin type III had tumor invasion in the carotid artery and adjacent tissues were in an adherent state. Therefore mass resection was carried out by resecting 2 cm of the distal portion of the common carotid artery and 3 cm of the proximal portion of the internal carotid artery. 6 mm of synthetic polytetrafluoroethylene graft was interpositioned between the common carotid artery and the internal carotid artery. External carotid artery was anastomosed to this graft in an end-to-end fashion. The patient developed vocal cord paralysis postoperatively on the lesion side. The patient who underwent bilateral tumor excision developed Baroreflex Failure Syndrome. In the two patients thrombus developed in the internal carotid artery in the early postoperative period. These patients underwent thrombectomy and developed hemiplegia on the lesion side. One of them died on the seventh post-operative day while in follow-up in the intensive care unit. Surgical resection is the recommended treatment for carotid body tumors. Shamblin I and II type tumors' dimensions and pathological characteristics allow dissection. However Shamblin III tumors may require carotid artery resection and reconstruction due to tissue invasion. The possibility of post-operative cranial nerve paralysis and arterial thrombosis should be taken into account.

The protective effects of intratympanic dexamethasone and vitamin E on cisplatin-induced ototoxicity are demonstrated in rats.

Cisplatin ototoxicity is a major dose-limiting factor in the treatment of several neoplasms. Dexamethasone and vitamin E are two slow-acting free radical cleaners, and they have been shown to ameliorate nephrotoxicity and endothelial cell damage in animals receiving cisplatin. The purpose of the study was to determine the effectiveness of vitamin E and dexamethasone as an otoprotectant intratympanically. Prospective, randomized controlled trial in the rat model. Wistar rats were sedated using 50 mg/kg intraperitoneal ketamine and 7.5 mg/kg xylazine. Baseline auditory brainstem response (ABR) testing was performed in response to clicks and 4.8-, 12-, 16-kHz tone bursts. After auditory thresholds were determined, the animals received intraperitoneal drug administration according to one of the four groups. The rat groups received (group I) % 09 NaCl solution intratympanically (IT), (group II) cisplatin (20 mg/kg) only intraperitoneally (IP), (group III) dexamethasone (0.1-0.3 ml) IT and (group IV) vitamin E solution (0.1-0.3 ml) IT followed after 30 min by 20 mg/kg cisplatin. After the 3-day follow-up, ABR testing was performed and threshold changes were recorded. Group II animals showed marked hearing loss with average threshold shifts of 39.7 ± 1.4 dB for clicks, 7.3 ± 2.6 dB at 4 kHz, 8.4 ± 1.6 dB at 8 kHz, 71.1 ± 4.2 dB at 12 kHz and 71.9 ± 5.9 dB at 16 kHz. No significant loss was observed in group III with shifts of 1.60 ± 1.3 dB, 4.75 ± 2.4 dB, 8.7 ± 3.4 dB, and 4.3 ± 2.1 dB for clicks and tone bursts at 4.8, 12, and 16 kHz, respectively. And similar findings were observed in group IV with shifts of 3.3 ± 1.4 dB, 7.2 ± 2.1 dB, 10.8 ± 2 dB, and 13.3 ± 3.1 dB for clicks and tone bursts at 4.8, 12, and 16 kHz, respectively. Significant protection was seen in group III and IV animals compared with group II animals. There is no side effect in IT administration of vitamin E and dexamethasone for hearing functions and two of them appear to have a easier, safer, usable protective effect against cisplatin ototoxicity.

Myeloperoxydase expression in the pathogenesis of nasal polyps.

Nasal polyps are benign mucosal protrusions that expand into the nasal cavity. There are no any etiological factors that may explain the pathogenesis of nasal polyps but currently inflammation continues to be the major factor. As a result of inflammation, neutrophils become activated and migrate to the inflammatory area and form their bactericidal effects by producing free oxygen radicals. The objective of our study is to investigate the expression of myeloperoxydase enzyme, which is usually an indicator of leukocyte infiltration and is responsible in the formation of free oxygen radicals in polyp tissues and to determine its role in the pathogenesis of nasal polyps.

The effects of allergic rhinitis on growth, development and body mass indexes in school children.

OBJECTIVE: The purpose of this study is to determine the frequency of allergic rhinitis (AR) in children and investigate if allergenic rhinitis demonstrated any effects on developmental growth levels and body mass indexes (BMI) in children. MATERIALS AND METHODS: 651 students, between 3-15 years of age who were randomly selected from four elementary schools located at Kartal, Istanbul were assessed according to symptoms and the presence of AR by nasal examination with the aid of a 0 degree 2.7 mm hand rigid endoscope. Height and weight percentile values of students regarding growth according to age and their BMI were calculated and statically assessed. Results obtained are presented. RESULTS: Findings obtained from a questionnaire and clinical examination does not allow us to perform a definite differentiation regarding in school children at age 3-5. The prevalence of AR in girls is higher. However, there are no any significant differences regarding BMIs in children with or without AR (p < 0,142). But there are statistically significant differences regarding height and weight percentiles in children with and without AR. Accordingly, there was a tendency in children diagnosed with AR to display low values related with height and weight percentiles. In Pearson chi-square testing, p values of percentile values related with weight (p < 0,032) and p values of percentiles related with height (p < 0,001) were determined. CONCLUSION: AR prevalence was higher in girls independently from BMI values. We determined a strong relationship between BMI values and AR dependant to age and gender.

Rosai-Dorfman disease: sinus histiocytosis with massive lymphadenopathy.

A 25-year-old man presented with a 3 month history of a painless mass on the right side of his neck. Physical examination revealed a smooth surfaced, bilobed, 4×3 cm, semimobile mass at the right and 3×2 cm at the left jugulodigastric region. Endoscopic examination of the patient showed a granular tumour in both nasal cavities. After biopsies were taken from the mass from the nasal cavity, a diagnosis of Rosai-Dorfman disease was made. A conservative approach was taken to treatment and after the 6 month follow-up period, the patient was in a stable condition.

Prevalence of adenoid hypertrophy and nocturnal enuresis in primary school children in Istanbul, Turkey.

OBJECTIVE: The purpose of this study is to investigate the prevalence of an existing relationship between adenoid hypertrophy and nocturnal enuresis in primary school children. METHODS: The study was performed in four primary schools that were chosen randomly in Kartal, Istanbul. The children's parents were asked to fill out a questionnaire that included questions concerning the associated symptoms of adenoid hypertrophy and nocturnal enuresis. The interrelations between adenoid hypertrophy and nocturnal enuresis items were examined by X2 tests. RESULTS: The study population consisted of 1132 (625 girls, 621 boys) primary school children between 5 and 14 years of age (mean 9.59+/-2.60 years). The children were divided into three groups with 5-7 years old children in Group I (n=232), 8-10 years old children in Group II (n=506) and 11-14 years old children in Group III (n=394). Of the 1132 distributed questionnaires, 1090 (87.4%) were filled in adequately and were accepted for evaluation. Prevalence of adenoid hypertrophy in school children was found to be 58 in Group I (27%), 94 in Group II (19.5%) and 78 in Group III (19.9%). Prevalence of nocturnal enuresis in school children was found to be 35 in Group I (15.1%), 51 in Group II (10.1%) and 18 in Group III (4.6%). No statistically significant association was present between adenoid hypertrophy and nocturnal enuresis in either Group I, II or III school children. CONCLUSION: In contrast to previous studies, our prevalence study did not find an association between adenoid hypertrophy and nocturnal enuresis. Thus, this prevalence study provides otolaryngologists new and interesting information.

Role of the 30 degrees telescope in evaluation of laryngeal masses during direct laryngoscopy.

SUMMARY: Visualization of enlarged laryngeal lesions is the most important factor in choosing a surgical technique, especially for partial surgery. For this reason standard microlaryngoscopy, a computed tomography (CT) scan of the larynx, and 30 degrees telescopic microlaryngoscopy were compared during evaluation of the laryngeal ventricul and sub-glottic area. The histopatholgoical findings of the specimens collected under each modality were simultaneously compared. Comparison of the histopathological findings, which corresponded to inspection with the 30 degrees telescopic method, was more significant than with the use of standard microlaryngoscopy or the CT scan. The aim of the current study therefore was to determine the importance of the 30 degrees telescopic microlaryngoscopic method for the evaluation of the laryngeal ventricle and subglottic area.

[Clinical signs and management strategies in thyroid masses]. / Tiroid kitlelerinde klinik bulgular ve uyguladigimiz tedavi yöntemleri.

OBJECTIVES: Patients who underwent surgery for thyroid masses were evaluated with regard to clinical symptoms, diagnostic and treatment methods, and the results of treatment. PATIENTS AND METHODS: The study included 92 patients (72 women, 20 men; mean age 45 years; range 16 to 71 years). Clinical diagnoses were based on findings of ultrasonography, thyroid function tests, thyroid scintigraphy, and fine-needle aspiration biopsy. Operations performed were near-total thyroidectomy (n=40), hemithyroidectomy (n=25), bilateral subtotal thyroidectomy (n=16), and total thyroidectomy (n=11). Patients with carcinoma associated with neck lymph node metastasis also underwent lateral, anterolateral, modified radical, or radical neck dissections. RESULTS: Postoperative histopathologic diagnoses were benign colloid nodule (n=70), papillary carcinoma (n=16), medullary carcinoma (n=2), anaplastic carcinoma (n=2), and Basedow-Graves disease (n=2). Unilateral vocal cord paralysis developed in 11 patients (11.9%), five of which persisted beyond one year follow-up. Two patients (2.2%) had transient hypocalcemia and one patient (1.1%) had postoperative hematoma. CONCLUSION: Preoperative determination of the structure and confines of thyroid masses increases success rates of surgical procedures and minimizes complication rates.

An alternative surgical approach for sublingual dermoid cysts: a case report.

A 52-year-old woman presented with a painless swelling in the floor of the mouth. She stated that it had existed there for 40 years and had undergone a gradual enlargement within the past year. Examination showed a mass, 5x4 cm in size. An aspiration from the lesion revealed a cyst. The lesion was removed by a U-shaped superior based flap. Histopathological examination showed stratified squamous epithelium lining the cystic lumen. This technique can be an alternative approach in such lesions because it protects the oral mucosa by providing good exposure, and prevents injury to the lingual nerve and submandibular duct.

[The effect of topical mitomycin-C application before or after incisional myringotomy on patency times of guinea pig tympanic membrane perforations]. / Kobay timpan membraninda mitomisin-C uygulamasinin insizyonel miringotominin kapanma süresine etkisi.

OBJECTIVES: The aim of this study was to investigate the effect of topical mitomycin-C application before or after incisional myringotomy on patency times and to asess its use as an alternative to ventilation tube insertion. MATERIALS AND METHODS: Nineteen guinea pigs were divided into two groups. In the study group (n=11), mitomycin-C was applied in a concentration of 0.4 mg/ml over the perforation for five minutes before (n=6) or after (n=5) incisional myringotomies in both ears. Control animals (n=8) received 0.1 ml 0.09% NaCl for the same duration. Evaluations were made on days 1, 3, 5, 7, 10, 14, and 21. The patency times, otorrhea, and other complications were recorded. RESULTS: Compared to controls (7.0+/-1.5 days), the mean patency times of perforations were significantly longer in mitomycin-C treated groups before (11.6+/-5.2 days) and after (14.2+/-4.7 days) incisional myringotomies (p<0.05). Patency times did not differ significantly between the two mitomycin-C groups. None of the ears exhibited permanent perforation. CONCLUSION: The length of patency provided by mitomycin-C is not sufficient for optimal ventilation in otitis media with effusion. However, in cases requiring shorter patency times, mitomycin-C application before or after myringotomy may be an alternative to ventilation tube insertion.

Does topical N-acetylcysteine application after myringotomy cause severe otorrhea?

OBJECTIVES: The effect of topical N-acetylcysteine (NAC) application was investigated on the healing of acute experimental tympanic membrane perforations. MATERIALS AND METHODS: Twenty guinea pigs were used in this study. Under intraperitoneal ketamine anesthesia, incisional myringotomies were performed in the posterosuperior quadrant of the tympanic membranes with a straight otologic hook. The diameter of the perforations was approximately 2 mm. Perforations in both ears were treated with freshly prepared sponges soaked in either 0.1 ml 0.9% NaCl solution (10 control animals) or 0.6 mg/0.1 ml NAC (10 animals) for three consecutive days. All the tympanic membranes were examined by otomicroscopy on the third, fifth, seventh, and ninth days. RESULTS: In the control group, all the perforations were completely closed at the end of nine days. During the same period, only 40% of the perforations were completely closed in the NAC group. The remaining ears exhibited otorrhea by the third day. CONCLUSION: N-acetylcysteine may cause severe otorrhea in the healing process of tympanic membrane perforations. Further studies including histopathological examinations are required to elucidate this condition.

The effect of topical insulin application on the healing of acute tympanic membrane perforations: a histopathologic study.

The aim of the present study was to investigate the effects of insulin on the healing of acute traumatic tympanic membrane (TM) perforations by observing the duration of perforation closure clinically and by examining the TM thickness, fibroblastic reaction, neovascularization and collagenization histologically. In all, 24 adult healthy guinea pigs were used. TM perforations, about 2 mm in diameter were made in the pars tensa of each ear. The perforations in the right ears of the guinea pigs (study group) were treated with 1 IU of regular insulin (Humulin-R 100 IU/ml, Lilly) daily topically. The left ears of the guinea pigs (control group) were treated with saline solution daily. The treatments were continued until the each perforation closed. The animals were examined with otomicroscopy at first, third, fifth and seventh days. TM specimens were obtained after the animals were decapitated under deep anesthesia by an intraperitoneal injection of sodium pentobarbital (0.5 ml/100 g) 3 and 7 days after wounding. Histologically, the epithelial and mucosal layers were examined. Finger-like projections, the edema of the LP, neovascularization of LP, fibroblastic activity of LP, inflammatory cell presence of LP, collagenization ratios of LP were evaluated. In the study group; LP fibroblastic reaction positivity and LP collagenization positivity was significantly higher than the control group (P < 0.001 and P < 0.05). Topical insulin treatment may be more beneficial in the treatment of atrophic membrane, which is a sequel of perforation, when tried in various dosages and time intervals.

The effects of radiofrequency and incisional myringotomy on the duration of patency.

OBJECTIVES: We investigated whether radiofrequency could prolong the patency of myringotomy. MATERIALS AND METHODS: Eighteen guinea pigs were enrolled in this study. Myringotomies were created by radiofrequency in the right ears in the study group using the ENTec coblator plasma surgery system, while the left ears had incisional myringotomies as the control group. After myringotomies, the tympanic membranes were examined with otomicroscopy on the 5th, 7th, 10th, and 14th days. Closure times of the two groups were compared by the Mann-Whitney U-test. RESULTS: All the myringotomies were closed up to the tenth postoperative day. There was no significant difference between the two groups with respect to closure times. CONCLUSION: Radiofrequency is a safe and minimally destructive method to perform a myringotomy, but it does not provide long-time patency.

[The effect of topical application of 5-fluorouracil on patency times after incisional myringotomy of guinea pig tympanic membrane]. / Kobay timpanik membraninda insizyonel miringotomi sonrasi uygulanan 5-florourasilin miringotominin kapanma süresine etkisi.

OBJECTIVES: We investigated the effect of topical application of 5-fluorouracil after incisional myringotomy on the patency time and its use as an alternative to ventilation tube insertion. MATERIALS AND METHODS: Experimental tympanic membrane perforations were induced in two groups of guinea pigs. One group (20 tympanic membranes) was treated with a 50 mg/ml 5-fluorouracil-soaked sponge over the perforation for five minutes while the other (16 tympanic membranes) with saline-soaked sponges for the same duration. The patency times, otorrhea, and other complications were recorded. RESULTS: The mean patency of tympanic membrane perforations following incisional myringotomy was significantly longer in the 5-fluorouracil-treated group (11.3 days vs 7.0 days; p<0.01). None of the ears exhibited permanent perforation. CONCLUSION: The length of patency provided by 5-fluorouracil is not sufficient for optimal ventilation time in otitis media with effusion. However, in circumstances in which shorter patency times may provide sufficient ventilation, 5-fluorouracil application may be an alternative to ventilation tube insertion.