The Relationship Between Destruction Sites and Clinical Findings in Diffuse Paranasal Sinus Mucoceles.

Objective: This study aimed to investigate that complicated mucoceles of paranasal sinuses and their clinical presentation, complications of relations with size, destructions areas, extension limits in affected patients. Materials and methods: A retrospective review was performed on patients who were diagnosed and treated as paranasal sinus mucoceles at ENT department from 2002 to 2013 years. Patients' demographic data, mucoceles location, symptoms, surgical approach and complications were evaluated. Results: The study group included 9 male and 10 female patients with a mean age of 45,0 years (range, 12-76 years). This case series include fronto-ethmoidal complex (52,6%), followed by frontal (26,3%), maxillary (15,7%) and sphenoid sinus mucoceles (5,2%). Endoscopic sinus surgery (ESS) was performed on 11 patients (57.8%); endoscopic procedures included marsupialization through an infundibulotomy, associated with an anterior ethmoidectomy and maxillary sinus antrostomy. Four patients (21%) underwent an external surgical procedure. 8 patients (42%) were treated by a combination of both endoscopic and external approaches such as trephination of the anterior wall of the frontal sinus, osteoplastic flap approach, Caldwell-Luc operation, anterior craniotomy and Lynch procedure. Complications occurred only in 2 cases (10.5%). Conclusion: The majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic and intracranial symptoms. A satisfactory outcome can be achieved after surgical treatment of both endoscopic and external approaches.

Arteriovenal Malformation in Parotid Gland.

Arteriovenous malformation (AVM) is an abnormal vascular formation where the artery and vein are connected directly to each other without capillary connections. Although it is common in the head and neck region, AVMs located in the parotid gland are quite rare. A 12-year-old female patient presented to our clinic with a mass in her left cheek area. As a result of physical examinations and tests, she was diagnosed with an AVM limited to the left parotid gland superficial lobe. Clinical follow-up was performed for AVM which has no sign except for prominence with Valsalva and surface temperature increase. The case was presented with a literature review.

Construction, characteristics and high throughput molecular screening methodologies in some special breeding populations: a horticultural perspective.

Advanced marker technologies are widely used for evaluation of genetic diversity in cultivated crops, wild ancestors, landraces or any special plant genotypes. Developing agricultural cultivars requires the following steps: (i) determining desired characteristics to be improved, (ii) screening genetic resources to help find a superior cultivar, (iii) intercrossing selected individuals, (iv) generating genetically hybrid populations and screening them for agro-morphological or molecular traits, (v) evaluating the superior cultivar candidates, (vi) testing field performance at different locations, and (vii) certifying. In the cultivar development process valuable genes can be identified by creating special biparental or multiparental populations and analysing their association using suitable markers in given populations. These special populations and advanced marker technologies give us a deeper knowledge about the inherited agronomic characteristics. Unaffected by the changing environmental conditions, these provide a higher understanding of genome dynamics in plants. The last decade witnessed new applications for advanced molecular techniques in the area of breeding,with low costs per sample. These, especially, include next-generation sequencing technologies like reduced representation genome sequencing (genotyping by sequencing, restriction site-associated DNA). These enabled researchers to develop new markers, such as simple sequence repeat and single- nucleotide polymorphism, for expanding the qualitative and quantitative information onpopulation dynamics. Thus, the knowledge acquired from novel technologies is a valuable asset for the breeding process and to better understand the population dynamics, their properties, and analysis methods.

Comparison of Cold Technique Tonsillectomy and Thermal Welding Tonsillectomy at Different Age Groups.

The aim of this study is to compare objectively advantages and disadvantages of cold technique tonsillectomy and thermal welding tonsillectomy at the same case. A total of 100 patients, 53 patients younger than 12 years of age and 47 patients elder than 12 years of age, were included in this study. Tonsillectomy was performed by using cold technique on the right side of the palatine tonsils and thermal welding on the left side. Right and left sides were compared regarding perioperative bleeding, surgical dissection time, postoperative pain scale at the 1st and 7th day and postoperative bleeding parameters. Perioperative bleeding was found to be higher in cold technique side in patients younger than 12 years of age (p<0.001). Postoperative pain score on the day 1 was significantly higher in cold technique side, whereas it was found to be higher in thermal welding side at postoperative day 7 (p<0.001). Perioperative bleeding was found to be significantly higher in cold technique side (p<0.001) and surgical dissection time of thermal welding was found to be longer (p<0.001) in patients elder than 12 years of age. Postoperative pain score at the day 1 and day 7 was found to be higher in thermal welding side (p<0.001). Postoperative pain score at the day 1 and day 7 were statistically significantly higher in patients elder than 12 years of age. As a result, both techniques have its unique superior aspects and both can be applied as a routine tonsillectomy technique.

Maxillectomy for Cementifying Osseous Dysplasia of the Maxilla: A Case Report.

OBJECTIVES: Osseous dysplasias are the most common subtype of fibro-osseous lesions of the maxillofacial bones. They are benign and often present as incidental asymptomatic lesions. Diagnosis can be made with clinical and radiographic examination. CASE REPORT: This article reports the case of a 47-year-old man with a huge cementifying osseous dysplasia of the maxilla that presented with secondary infection after teeth extraction and repair of oroantral fistula. A subtotal maxillectomy had to be done after conservative treatment failed to resolve the infection. DISCUSSION/CONCLUSION: Biopsy, tooth extraction or surgical trauma to the affected bones of osseous dysplasia could easily lead to severe secondary infection, the treatment of which may be very difficult, and thus should be avoided if possible.

The Evaluation of Relationship Between Body Mass Index and Nasal Geometry Using Objective and Subjective Methods.

INTRODUCTION: It is known that obesity causes obstructive sleep apnea syndrome by increasing upper airway resistance. Also, obese patients are admitted to the ear, nose, and throat clinic very often because of nasal obstruction complaint. The aim of this study is to identify the change and relation among body mass index (BMI), nasal resistance, reduction in nasal ariflow, nasal anatomy, and patients' subjective complaints. MATERIAL AND METHOD: A total of 67 patients admitted to our clinic between August 2013 and January 2014 were included in the study.The study group comprised 33 patients who had a chief complaint-nasal obstruction and the other group consisted of 34 patients who had no complaint and nasal pathology. Both the groups were checked with acoustic rhinometry (AR), active anterior rhinomanometer, nasal obstruction symptom evaluation (NOSE), and visual analog study (VAS) questionnaire. RESULTS: There is a significant statistical correlation between the body mass increase and VAS and NOSE score increase (P < 0.05). But the authors did not find any statistically significant relation between BMI and total inspiratory and expiratory MR and MF measured by anterior active rhinomanometer and left and right nasal cavity MCA, and volume measured by acoustic rhinometery (P > 0.05). CONCLUSIONS: Contrary to belief, obesity does not change the nasal resistance, airflow, and anatomy but it can cause subjective nasal complaints.

Is There a Relationship Between Bell's Palsy and Internal Auditory Canal?

In the present study, we evaluated the diameter of internal acoustic canal in patients with Bells palsy to investigate the role of anatomical differences of the temporal bone in etiology of Bell's palsy. Sixty-four patients who were diagnosed as Bells Palsy and temporal bone computed tomography imagings of them were included into the study group (Group 1). The control group (Group 2) was consisted of 35 healthy subjects without Bell's Palsy. All patients had temporal bone computed tomography imaging. The internal auditory canal inlet, mid-canal, outlet and canal lengths were measured at the most distinctive cross-section of the seventh and eighth cranial nerves bifurcation. In the study group, Bells palsy was on the right side in 26 patients (40.6 %) and on the left side in 38 patients (59.4 %). Initial House-Brackmann (HB) score was HB-2 in 29 patients (45.3 %), HB-3 in 18 patients (28.1 %), HB-4 in 13 patients (20.3 %) and HB-5 in 4 patients (6.2 %). At 6-month evaluation, HB-score of the patients were HB-1 in 37 patients (57.8 %), HB-2 in 25 patients (39.1 %) and HB-3 in 2 patients (3.1 %). Internal auditory canal (IAC) measurements of the groups showed that there were no significant differences between the measurements of right-mid canal, right canal length; and left canal outlet and left canal length of the study and control groups. Right inlet and outlet; and left inlet and mid-canal values of the study group (Bell's palsy) were significantly lower than those of the control group. In Bell's palsy group, left inlet, outlet and canal length values were significantly higher than those of the right ones. Correlation analysis showed that there were no significant correlation between paralysis side; initial HB stage; and IAC measurement results. In patients with higher initial HB score, their 6-month later HB-score was also higher. In patients with higher 6-month HB score; R canal inlet, R mid-canal, L-canal inlet, and L-mid canal values were lower. Lower IAC inlet and mid-canal values were detected in patients with Bell's palsy. Therefore narrow IAC inlet and mid-canal values may be one of the risk factors for Bell's palsy.

Vocal fold paresis accompanying vocal fold polyps.

The aim of this study was to evaluate patients with vocal fold polyps using laryngeal electromyography (LEMG) for the presence of vocal fold paresis and to compare transnasal fiberoptic and rigid stroboscopic findings between polyp patients with normal LEMG and with vocal fold paresis. Thirty-five patients with a vocal fold polyp underwent transnasal fiberoptic laryngoscopy, rigid laryngostroboscopy, and LEMG. The findings were compared between the LEMG-confirmed vocal fold paresis patients and the normal LEMG patients. LEMG resulted in a diagnosis of unilateral or bilateral vocal fold paresis in 17 of 35 patients (48.6 %). More men than women with vocal fold polyps had vocal fold paresis (p < 0.05). The vocal fold paresis group had higher presence of axial rotation and hypomobility of vocal folds, higher asymmetry of vertical height of vocal folds, and less presence of longitudinal stretch of vocal folds (p < 0.05). Medial-lateral compression of the false vocal folds and anterior-posterior approximation of the larynx did not show any difference between the groups. No significant difference was found in vibratory wave characteristics between the groups through rigid laryngostroboscopy. Vocal fold paresis was present in almost half of the patients with vocal fold polyps. Paresis can only be accurately diagnosed with LEMG. Transnasal fiberoptic laryngoscopic examination is helpful to recognize vocal fold paresis in vocal fold polyp patients, while stroboscopic examination is not useful to identify it in vocal fold polyp patients.

Sudden hearing loss and vertigo after tooth extraction successfully treated with combined therapy including HBO2: a case report.

Sudden sensorineural hearing loss (SSNHL) is a decrease in hearing of at least 30 dB that occurs within three days and which affects at least three consecutive frequencies in either ear or both ears. This case report describes a woman who had sudden hearing loss and vertigo in the right ear after tooth extraction. As the first-line therapy, systemic and intratympanic steroid injections were used this led to a slight improvement; however, the majority of improvement in hearing was not observed until hyperbaric oxygen (HBO2) therapy was instituted on the 20th day of hearing loss. Sudden hearing loss and vertigo after tooth extraction is an otologic emergency and early evaluation and treatment are effective. HBO2, although employed beyond the Undersea and Hyperbaric Medical Society's recommended initial 14 days of symptom onset, very was effective for this particular case.

Quality of life in patients with persistent allergic rhinitis treated with desloratadine monotherapy or desloratadine plus montelucast combination.

OBJECTIVES: This study aims to compare the effectiveness of desloratadine monotherapy and desloratadine plus montelukast combination therapy on quality of life in patients with persistent allergic rhinitis. PATIENTS AND METHODS: This study consists of 40 patients (28 females, 12 males, mean age 29.8 years; range 17 to 44 years) referred to ear, nose, and throat outpatient clinic between May 2010 and September 2010. A six-week randomized, double-blind, cross-sectional study was performed in two arms: In group 1, 20 patients received desloratadine (5 mg/d) alone; in group 2, 20 patients received desloratadine (5 mg) plus montelukast (10 mg) combination therapy. Quality of life was assessed on the day before starting treatment and on the last day of each treatment period using the Rhinoconjunctivitis Quality of Life Questionnaire and Nighttime Symptom Scores. RESULTS: In group 1, the mean quality of life scores before and after treatment were 3.17 and 2.43, respectively. In group 2, the mean quality of life scores before and after treatment were 2.94 and 1.73, respectively. CONCLUSION: Desloratadine plus montelukast combination therapy may have a positive impact on quality of life, sleep symptoms in particular.

[Evaluation of benign vocal cord lesions with laryngeal electromyography]. / Benign vokal kord lezyonlarinin larengeal elektromiyografi ile degerlendirilmesi.

OBJECTIVES: This study aims to identify patients with benign vocal cord lesions using laryngeal electromyography (EMG) and to investigate the presence of accompanying vocal cord paresis. PATIENTS AND METHODS: Twenty-eight patients (18 males and 10 females; mean age 38.6±10.2 years; range 22 to 59 years) who were diagnosed with benign vocal cord lesion using a rigid laryngostroboscopy underwent laryngeal EMG and the presence of neurogenic involvement was investigated. RESULTS: Laryngostroboscopic examination revealed polyp in 85.7% (n=24), Reinke's edema in 10.7% (n=3), submucosal cyst in 10.7% (n=3), and contact granuloma in 3.6% (n=1). Of the patients, 14.2% (n=4) were suspected to have vocal cord paresis. Laryngeal EMG revealed neurogenic involvement in at least one of the larynx muscles in 57.2% (n=16) of the patients. Eight patients (28.6%) had unilateral neurogenic involvement, while three (10.7%) demonstrated isolated recurrent laryngeal nerve paresis two (7.2%) demonstrated isolated superior laryngeal nerve paresis, and three (10.7%) demonstrated combined recurrent and superior laryngeal nerve paresis. Six (21.4%) of eight patients with bilateral neurogenic involvement had paresis in three laryngeal nerves, whereas in two (7.2%) patients four laryngeal nerves were affected. CONCLUSION: Our study shows that vocal cord paresis frequently accompanies benign vocal cord lesions. Laryngeal EMG is useful to identify clinically suspected or unsuspected paresis with physical examination precisely.

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.

Severe destruction of the upper respiratory structures after brief exposure to a dieffenbachia plant.

Dieffenbachia is a common domestic plant. Oral contact with the plant generally causes slight effects, but when chewed it may result in painful oropharyngeal edema. Even though the mechanism through which this plant causes toxicity is not known, calcium oxalate crystals (rhaphides) and protease in the idioblast of the plant are considered to be the causes. Our aim was to show the lethal effects of a common domestic plant named Dieffenbachia.A 70-year-old male patient applied to our clinic with aphasia, dysphagia, sialorrhea, wounds on the lips and tongue, and swelling on the face. There was edema on his tongue, soft palate, uvula, anterior pharyngeal plica, epiglottis and aryepiglottic fold, and ulceration on the right side of his tongue, the right cheek mucosa, right-lower gingival, soft palate, tongue base, epiglottis anterior surface, and free edge.Dieffenbachia toxicity presents both minimal and serious problems, which can be life threatening, as in our case. Toxic cases resulting in serious clinical pictures due to Dieffenbachia are rare.

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.

Fibromyxoma of the frontal sinus.

Fibromyxomas are uncommonly encountered pathologies in the head and neck region. They are slow growing, which result in expansion of the surrounding bony cortices. In this article, we report an extremely rare case of frontal sinus fibromyxoma which occluded the frontal sinus and expanded anterior ethmoid cells and nasal dorsum. Initially, it was suspected to be a mucocele. Surgical resection with a wide excision was performed and it was diagnosed as fibromyxoma, histopathologically.

Huge internal carotid artery aneurysm presenting as tonsillar asymmetry.

Aneurysms of the extracranial portion of the carotid artery are extremely rare. Internal carotid artery aneurysm is an uncommon cause of tonsillary asymmetry. Although internal carotid artery aneurysms usually remain asymptomatic, the clinical manifestation requires the tonsillar enlargement. Asymmetry as a sole determining factor for tonsillectomy may lead to unnecessary operations. We report a patient with a giant internal carotid artery aneurysm presenting as tonsillary asymmetry that might be mistaken for a tonsillar neoplasia. When faced with a tonsillar asymmetry, an otolaryngologist must keep aneurysms in mind.

Expression of cathepsin D and E-cadherin in primary laryngeal cancers correlation with neck lymph node involvement.

OBJECTIVE: The aim of this study was to investigate the relation between Cathepsin D (Cath-D) and E-Cadherin (E-Cad) expression levels in tumor tissue and neck lymph node metastasis. This attempt should be made to identify new factors that one could be useful in predicting clinical behavior. STUDY DESIGN: In this study, we investigated rates of dying for E-Cad and Cath-D in paraphin blocks of larynx and neck dissection specimens taken from 56 selected patients. Laryngeal specimens dyed by ECad and Cath-D immunohistochemically. Immunoreactivity classified for E-Cad as positive (75% and above), reduced (25-75%) and negative (below 25%). Immunoreactivity classified for Cath-D:dye absorption rates higher than 50% evaluated positive and absorption rates lower than 50% evaluated negative. We compared the rates of dying for E-Cad and Cath-D groups to with or without neck lymph node metastasis in specimens. RESULTS: Neck metastasis were found in 41% of patients, in 55.6% of patients, if the E-Cad was negative, 40.6% if it was reduced, 33.3% if it was positive in specimens. The neck metastasis was found in 35.4% of patients with Cath-D expression negative, while 75% of patients was found with Cath-D expression positive. CONCLUSION: Neck metastasis was found higher in E-Cad reduced group than positive group. Neck node metastasis was significantly higher in Cath-D positive group than Cath-D negative group. Cath-D and E-Cad essays may useful in identifying neck lymph node involvement. Cath-D expression levels are more in this predictive factor than E-Cad levels for possibility of neck lymph node metastasis in LSCC.

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.

Myeloperoxydase activity in the pathogenesis of cholesteatoma.

OBJECTIVE: The aim of this study was to determine the effect of myeloperoxydase (MPO) in bone destruction in patients of chronic otitis media (COM) with cholesteatoma by immtino-histochemical staining and to conclude the possible relationship between bone destruction in patients with cholesteatoma accompanied with COM and MPO activity. METHODS: The study was conducted on a total number of 81 patients where 51 of the patients were enrolled in the "patient group" and 30 of the patients were enrolled in the "control group" whom were operated due to otitis media. MPO positivism was monitored when a cytoplasmic staining process was performed. RESULTS: Meanwhile, a significant difference is present at a statistically advanced level between the MPO levels of groups (p = 0.001; p < 0.01). However, MPO activity is absent in patients included in the control group or it can be observed at a very slight level. A moderate level or intense level of activity can be observed in patients enrolled in the study group. Excluding the destruction at the dura, all findings related with the middle ear and the erosion of the mastoid cavity and MPO activity indicated a statistically significant difference (p < 0.05). According to the destruction at the wall of the dura bone, distribution of MPO activity did not display a statistically meaningful difference (p > 0.05). CONCLUSION: In this study, we investigated the relationship between MPO level and bone destruction and found a significant level of correlation among the fore said. A new era may be opened in the treatment of cholesteatoma when preoperative MPO levels are determined and adequate information is obtained related with bone erosion.