Impact of adenotonsillectomy on ADHD and nocturnal enuresis in children with chronic adenotonsillar hypertrophy.

OBJECTIVE: Children with chronic adenotonsillar hypertrophy (CAH) are more likely to have symptoms of attention deficit hyperactivity disorder (ADHD) and enuresis nocturna (EN) and benefit from surgery. The aim of this study was to evaluate the effect of adenotonsillectomy on ADHD and EN symptoms in children with CAH. STUDY DESIGN: Cross-sectional study was conducted. SETTING: Parent-based questionnaires. METHODS: Parents of children with CAH were given Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV) and Nocturnal Enuresis Questionnaire (NEQ) before and six months after adenotonsillectomy. Inattention (IA) and hyperactivity-impulsivity (HI) subscores of T-DSM-IV were used in the present study. The rates of ADHD and EN were compared before and after surgery. RESULTS: A total of 75 children between 5 and 16 years of age and their families participated in the study. All 75 families completed T-DSM-IV and NEQ. Mean IA (5.69 ± 4.88 versus 4.46 ± 4.40) and HI (6.53 ± 5.60 versus 5.93 ± 5.45) scores as well as total ADHD scores (12.22 ± 8.99 versus 10.42 ± 8.70) improved significantly after surgery. This significance was found to be statistically important (p<0.05). Furthermore 26 of the subjects were diagnosed with primer EN before adenotonsillectomy and 14 of these enuretic children had total remission six months after surgery. The frequency of EN dropped from 34.7% to 16.0% and this remission rate was found to be statistically significant (p<0.05). CONCLUSION: Children with CAH had high frequency of ADHD and EN symptoms in the present study. Adenotonsillectomy was found to be effective in improvement of these symptoms.

The effects of hypotensive anaesthesia on otoacoustic emissions: a prospective, randomized, double-blind study with objective outcome measures.

The aim of the present study was to compare pre- and post-operative otoacoustic emission examinations of patients who experienced surgery under hypotensive anaesthesia using distortion product otoacoustic emission (DPOAE) and transient evoked otoacoustic emission (TEOAE). Forty-one patients, admitted to our tertiary centre for nasal valve surgery, were prospectively and randomly assigned into two groups. Hypotensive group included 20 patients, while control group included 21 patients. All investigators and patients were blinded to anaesthesia assignment throughout the course of the study. DPOAEs and TEOAEs were performed before surgery and repeated after 15 days in both groups. In control group, DPOAE-DP1 levels per frequency increased significantly in the post-operative period when compared with the pre-operative values in all patients. However, DPOAE-DP1 levels decreased significantly in hypotensive group. Similarly, DPOAE-SNR levels per frequency decreased significantly in hypotensive group. In conclusion, we have observed that under the influence of hypotensive general anaesthesia, the amplitudes of OAEs are affected.

Tortuosity of the internal carotid artery detected during tonsillectomy: two case reports.

Tonsillectomy is one of the most common performed surgical procedures in childhood. Tortuosity of the internal carotid artery (ICA) is an anatomical variation of the course of the ICA, and can be seen at any levels along the course of the artery, even in lateral oropharyngeal wall. In this article, we present two cases in which ICA tortuosity detected as a pulsating mass in the lateral oropharyngeal wall in an eight-year and a five-year-old girls, during tonsillectomy.

A comparison of the efficacy of 5-fluorouracil/triamcinolone, carnitine and dexamethasone therapy on wound healing in tracheal injury: potential for preventing tracheal stenosis?

The aim of the study was to investigate the efficacy of 5-flourouracil/triamcinolone acetonide (5-FU/TA), carnitine and dexamethasone on wound healing in an animal model of tracheal injury. Twenty-eight rats underwent surgical injury of the tracheal mucosa and perichondrium under general anesthesia, and were randomized into four groups. Group I (the control group) received nothing after tracheal trauma. Group II received intratracheal 5 mg 5-FU/TA combined with 0.2 ml sodium hyaluronic acid once. Group III received intraperitoneal carnitine 100 mg/kg/day for 20 days. Group IV received intramuscular dexamethasone 0.1 mg/day for 20 days. After 1 month, the levels of superoxide dismutase enzyme activity (SOD) and levels of malondialdehide (MDA) and nitric oxide (NO) in serum were measured and the tracheal specimens were harvested for histopathologic examination. SOD was significantly lower in the carnitine group compared to the control group. A statistically significant decrease in MDA levels were observed in the 5-FU/TA and carnitine groups compared to the control group. NO levels were significantly lower in the 5-FU/TA group, but significantly higher in the dexamethasone group, compared to the control group. The fibrotic tissue volumes of tracheal specimens were significantly lower in both the 5-FU/TA and carnitine groups than those of the control group, but trended toward higher volumes in the dexamethasone group when compared to controls. We concluded that 5-FU/TA and carnitine diminish the occurrence of tracheal stenosis (TS) secondary to experimentally induced tracheal trauma.

Effect of pentoxifylline and 5-fluorouracil/triamcinolone on laryngotracheal stenosis developing as a complication of tracheostomy: study in rats.

We aimed to investigate the prophylactic effect of pentoxifylline (PTX) and 5-fluorouracil (5-FU) on laryngotracheal stenosis in tracheotomised rats by evaluating blood glutathione peroxidase (GPx) and superoxide dismutase activities and by histopathological evaluation of laryngotracheal segment. Randomized prospective single-blind study. Standard vertical tracheotomy was performed on 24 rats. Then, the animals were randomly divided into three groups. Intraperitoneal PTX administered to group A (study group) for 10 days. 5-FU was injected in paratracheal tissues in group B (study group) for 10 days. In group C (control group), intraperitoneal saline was administered for 10 days. After 10 days, tracheal cannules were removed. For biochemical analysis, two blood samples were obtained. Three weeks later, all animals were euthanized and trachea specimens were harvested. Stenosis index and mean wall thickness in PTX group were lower as compared to other groups but the difference was statistically insignificant. Minimum inflammation and fibrosis plus maximum epithelial regeneration were seen in PTX group. In addition, GPx activity was at highest level in PTX group and a statistically significant difference was found between control and PTX groups (P = 0.024) though the difference between remaining groups was statistically insignificant (P = 0.121). Superoxide dismutase activity was highest in PTX group but no statistically significant difference was found between the three groups (P = 0.305). The administration of PTX increases GPx activity and it may have some effect on tracheal scar formation which develops following tracheostomy.

Behcet's disease impairs voice quality without laryngeal and hypopharyngeal involvement.

The objective of the study was to investigate voice evaluation parameters in Behcet's disease patients. A prospective controlled study was performed in a tertiary referral center. A total of 31 patients (21 female, 10 male) with a diagnosis of Behcet's disease had voice evaluations by means of laryngostroboscopy, acoustic analysis, aerodynamic measurements and perceptual assessment. Data obtained from the patients were compared to 31 healthy control subjects. Laryngeal endoscopy was within normal limits in all patients. The mean fundamental frequency in male control subjects (134 ± 14 Hz) was significantly higher than in male patients (124 ± 20 Hz), (p = 0.043). Mean intensity was significantly higher in control subjects (74 ± 5 dB) than in the patients (63 ± 4.6 dB), (p < 0.001). Shimmer in patients (3.4 ± 2.5) was significantly higher than in control subjects (2 ± 1.3), (p = 0.01). Maximum phonation time in control subjects (25 ± 5.8 s) was significantly longer than in patients (20 ± 7.9 s), (p = 0.007), and s/z ratio was found to be nearly equal between patients (0.9 ± 0.2) and control subjects (0.96 ± 0.1), (p > 0.05). The patients showed a mean GRBAS score of 1.8 ± 1.9 and the control group showed a mean score of 0.48 ± 1.06, (p = 0.002). The VHI-10 scale revealed a mean score of 2.2 ± 4.8 in BD patients and 2 ± 2 in control subjects (p > 0.05). Behcet's disease impaired voice quality without laryngostroboscopically visible laryngeal and hypopharyngeal involvement. This impairment was documented by objective voice evaluation methods including acoustic analysis and aerodynamic voice measurements and by subjective voice evaluation method including perceptual assessment.

Histopathologic examination of routine tonsil and adenoid specimens: is it a necessary approach?

OBJECTIVES: This study aims to investigate whether it is necessary to perform histopathologic examination of the specimens of tonsillectomy and/or adenoidectomy. PATIENTS AND METHODS: In this retrospective and multicenter study, 1021 pediatric and adult patients (557 males, 464 females; median age 8 years; range 5 to 13 years) who underwent adenoidectomy and/or tonsillectomy were included. Of the patients, 809 (79.3%) were pediatrics, while 212 (20.7%) were adult. Age, gender, histopathologic diagnosis and risk for malignancy in the patients with malignant diagnosis were reviewed using present patient records. RESULTS: Adenotonsillectomy was performed on 396 patients (38.8%), tonsillectomy on 266 patients (26%) and adenoidectomy on 359 patients (35.2%). Of the 1021 patients, 1011 (99%) received a benign histopathologic diagnosis, while 11 (1%) receieved malignant diagnosis. Malignant diagnosis was present only in adult patients. All patients diagnosed with a malignancy had one or more preoperative risk factors. No unexpected malignant diagnosis was found in any of the patients without preoperative risk factors. CONCLUSION: We concluded that histopathologic diagnosis may not be required for the patients without preoperative risk factors, particularly pediatric patients.

Clinical and laboratory findings of tularemia: a retrospective analysis.

OBJECTIVES: This study aims to define demographic characteristics and clinical and laboratory findings of the patients with tularemia and to assess the treatment outcomes. PATIENTS AND METHODS: A total of 58 consecutive patients (26 males, 32 females; mean age 37±22 years; range 6 to 80 years) with tularemia were retrospectively analyzed in this study. Demographic characteristics, laboratory findings, physical examination findings and treatment outcomes were recorded. RESULTS: Forty patients (86.2%) had glandular tularemia; seven (12.1%) had oropharyngeal tularemia, and one (1.7%) patient had oculoglandular tularemia. The most common symptoms were swollen neck lymph nodes high fever and sore throat. Fifty seven patients (98.2%) had swollen neck lymph nodes; 39 (67.2%) patients had high fever (67.2%) and 36 (62.1%) patients had sore throat. Complete recovery was obtained in 45 patients (77.6%), while 13 (22.4%) were unresponsive to the treatment. The most frequent laboratory findings were high level of C-reactive protein (CRP) and increased erythrocyte sedimentation rate (ESR). Mean leukocyte counts, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine levels were within normal range in all patients. CONCLUSION: Tularemia should be differentiated from upper respiratory tract infections and cervical lymphadenopathy. The most commonly used hematological and biochemical assays do not provide significant benefits for the diagnosis of tularemia. However, increased level of ESR and CRP at one month may support the diagnosis. Early diagnosis and appropriate treatment may prevent therapeutic failure.

Immunohistochemical analysis of reconstructed sheep mandibles: transport distraction osteogenesis versus autogenous bone grafting.

PURPOSE: Although many studies have been conducted that related to growth factor expression in mandibular distraction osteogenesis, to our knowledge, no study comparing the immunohistochemical outcomes of autologous bone grafting (ABG) and transport distraction osteogenesis has been conducted up to now. The aim of this study was to histologically and immunohistochemically analyze newly formed bone in the resected mandible reconstructed by transport distraction osteogenesis and iliac crest bone grafting in a sheep model. MATERIALS AND METHODS: Mandibular discontinuity defects created in the jaws of sheep were reconstructed by distraction osteogenesis (n = 7) and bone grafting (n = 7) and allowed to heal for 3 mos. The animals were then sacrificed and their jaws resected and prepared for decalcification. Histological and immunohistochemical examinations of transforming growth factor-beta 1 (TGF-ß1) and bone morphogenetic protein (BMP) -2, -4 were performed in the newly formed bone in the defect area. RESULTS: Positive staining for BMP-2, -4, and TGF-ß was observed in the cells and matrix components. BMP is present in both processes, but the expression of BMP-2, -4, and TGF-ß in the distraction regenerate is stronger when compared with bone graft healing. CONCLUSIONS: The only limitation of the present study was that it evaluated the role of BMP-2, -4, and TGF-ß expressions in bone repair process at 3 mo postoperatively. Determination of growth factor expression at more than 1 time point would be ideal in elucidating the role of these factors during bone healing.

Does mitomycin-C increase collagen turnover as a modulator of wound healing in tracheostomyzed rats?

OBJECTIVES: This study aims to investigate the effect of mitomycin-C in the wound healing process on collagen synthesis in tracheostomyzed rats. MATERIALS AND METHODS: Fourteen healthy, in both sexes, mean weight of 270 g (range 250-300 g), Wistar-Albino type rats underwent tracheotomy and tracheal mucosa was damaged with micro-scissors on both sides of tracheostomyzed area. The rats were divided into two groups: The experimental group (group 1) received immediate topical application of mitomycin-C 0.2 mg/ml; the control group (group 2) received saline solution. The rats were sacrificed after a period of one month. Subsequently, the tracheostomyzed region was excised and vertically divided into the two parts. The level of hydroxyproline in the dry tissue was measured in one part of the tissue. Fibroblast count was performed in the other part of the tracheostomyzed region using the stereological method. RESULTS: The hydroxyproline level was much higher in the mitomycin-C group when compared to the control group (p<0.05). In contrary, the number of fibroblasts was lower in the mitomycin-C group than control group (p<0.05). CONCLUSION: When used in wound healing, mitomycin-C may increase collagen synthesis or quicken the wound healing process after one month.

Stereologic analysis of bone produced by distraction osteogenesis or autogenous bone grafting in mandible.

To our knowledge, in the literature, any other investigation that numerically compared osteoblasts retrieved from transport distraction osteogenesis and bone grafting procedures using stereological methods is not reported. The purpose of this study was to compare the total number of osteoblast cells at 3 months in bone produced by distraction osteogenesis and that in autogenous bone graft. A total of 19 growing sheep (male aged 7 or 8 mo; weighing between 21 and 28 kg) were used in this study. Mandibular discontinuity defects created in mandibles of sheep were reconstructed by transport distraction osteogenesis and iliac crest bone graft and allowed to heal for 3 months. The animals were then killed, and the jaws were resected and prepared to be decalcified. Stereological and histologic examinations were performed. Intramembranous ossification and osteoid and trabecular formations were observed in both groups. In the distraction group, the mean +/- standard deviation (SD) numerical density of the osteoblasts was found to be higher (0.0004866 +/- [0.000044])when compared with those of both the graft (0.0003458 +/- [0.000030]) and control groups (0.0002714 +/- [0.000022]). Statistically significant differences were found among the groups (P < 0.05). Stereologic evaluation of bone in the sheep model demonstrated significantly greater osteoblast density in bone formed through transport distraction osteogenesis when compared with bone grafting and the control. Therefore, further studies should be conducted to evaluate the differences in both osteoblastic and osteoclastic cellular activities at different time points in distraction osteogenesis and autogenous bone grafting to assess the healing process of bone for clinical applications.

Expressions of p53, cyclinD1 and histopathological features in basal cell carcinomas.

BACKGROUND: We planned this study to analyze probable associations between p53, cyclinD1, Ki67 and histopathological features in basal cell carcinomas (BCC). METHODS: Histological differentiation types, histological growth patterns and tissue responses were analyzed in 50 cases of BCC. In immunohistochemical analysis, p53, cyclinD1 and Ki67 antibodies were investigated. P53 expression was evaluated based on a cut-off value of 25% positivity. CyclinD1 expression was graded from 0 to 3+ according to the percentage of positive nuclear staining. The percentage of positively staining cells for Ki67 was recorded. RESULTS: The following significant correlations were detected. Solid infiltrative type differentiation was related to the infiltrative histological growth pattern. The rates of p53 positivity and severe fibrosis in the groups of mixed and infiltrative growth patterns were higher than others. Besides, p53-positive cases showed more severe fibrosis and had a higher mean value for Ki67 index. Epidermal p53 and cyclinD1 clones in normal epidermal areas adjacent to tumors were noticed in 42% and 52% of the cases, respectively. CONCLUSIONS: P53 expression seems to be related to Ki67 index and some histopathological features of BCC, such as infiltrative histological growth pattern and probably fibrosis.

Paradoxical vocal fold motion dysfunction in asthma patients.

BACKGROUND AND OBJECTIVE: Paradoxical vocal fold motion dysfunction (PVFMD) is a disorder of the larynx characterized by adduction of the vocal cords during the respiratory cycle leading to symptoms of extrathoracic airway obstruction. PVFMD mimics asthma and patients with PVFMD (PVFMD+) are often diagnosed incorrectly as refractory asthma and receive unnecessary treatment. This study determined the prevalence of PVFMD in asthma patients and described the relationship between asthma and PVFMD. METHODS: A descriptive study of 94 asthmatic patients and 40 control subjects, all of whom were examined via laryngoscopy and had pulmonary function tests were performed. RESULTS: The prevalence of PVFMD was 19% (n = 18) in the asthmatic group and 5% (n = 2) in the control group (P < 0.001). No relationship was found between presence of PVFMD, asthma attacks and asthma severity (P > 0.05). Laryngopharyngeal reflux and allergy were significantly more prevalent in the PVFMD+ group than in the group without PVFMD (PVFMD-) (P < 0.05). The most common symptoms in the PVFMD+ patients were difficulty in breathing (88%), inspiratory stridor (66%) and a choking sensation (50%) and the most common symptoms in PVFMD- asthmatic patients were cough (63%), dyspnoea (55%) and wheezing (51%). CONCLUSIONS: Asthma seems to facilitate the formation of the paradoxical dysfunction in the larynx as the prevalence of PVFMD in asthma patients is significantly higher than in patients with out asthma.

[Pediatric plunging ranula and its surgery with transoral approach: a case report]. / Pediyatrik plunging ranula ve agiz yolu yaklasimiyla cerrahi tedavisi: Olgu sunumu.

The plunging ranula is an uncommon condition which presents itself as a fluctuating swelling in the neck. It is less frequent during childhood. The ranula, which is usually originated from sublingual gland, is called the plunging ranula when it affects the submandibulary space and adjacent structures in the neck. There are a lot of different methods used in surgical treatment. In this study, we present a plunging ranula case which was performed by excision of the pseudocyst and ipsilateral sublingual gland with transoral approach in a five-year-old girl. There has been no recurrence in four-year follow-up period.

The effectiveness of nasal decongestants, oral decongestants and oral decongestant-antihistamines in the treatment of acute otitis media in children.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of nasal decongestants, oral decongestants and oral decongestant-antihistamines in the treatment of acute otitis media and resolution of the middle ear effusion in children. PATIENTS AND METHODS: 355 ears of 318 children [160 boys (179 ears) and 158 girls (176 ears)] who were diagnosed to have acute otitis media and treated for it with different drug regimens were evaluated retrospectively regarding resolution of the middle ear fluid. 151 ears were treated with antibiotics and analgesics (group 1), 64 with antibiotics, topical decongestants and analgesics (group 2), 81 with antibiotics, oral decongestants and analgesics (group 3), and 59 with antibiotics, oral decongestant-antihistamine combinations and analgesics (group 4). The children with middle ear effusion were followed up for three months. RESULTS: Group 1, 2, 3 and 4 had persistent middle ear effusion and the presence of middle ear effusion was 27.2%, 18.8%, 25.9%, 28.8% at the 1st month and 5.8%, 0%, 0% and 5.9% at the end of the 3rd month, respectively. At the end of the 3rd month, there was no significant difference between the groups regarding the resolution rates of the middle ear fluids in the antibiotic group and decongestants groups (p>0.05). CONCLUSION: We do not recommend the use of decongestants and antihistamines in the treatment of acute otitis media as they do not change the natural course of the disease.

[Relations between symptoms, durations and triggers of attacks and concurrent diseases in paradoxical vocal fold movement disorder]. / Paradoksal vokal kord hareketi hastaligi semptomlar, atak süreleri ve atak tetikleyicileri ile eslik eden hastaliklar arasindaki iliski.

OBJECTIVES: To discover the relation between initial symptoms, triggers and durations of attacks of paradoxical vocal fold movement disorder (PVFMD) and concurrent laryngeal and respiratory diseases. PATIENTS AND METHODS: Twenty one PVFMD patients (17 females, 4 males; mean age 50 year; range 31 to 72 years) were included in the study. Diagnosis of PVFMD was established when inspiratory and/or expiratory vocal cord adduction was seen during laryngostroboscopy. RESULTS: Laryngeal and respiratory diseases accompanying PVFMD were laryngopharyngeal reflux (n=15; 71%), asthma (n=11; 52%), allergic rhinitis (n=6; 28%), chronic sinusitis (n=1; 4%), right vocal cord paresis (n=1; 4%) and chronic obstructive pulmonary disease (n=2; 9%), (p=0.346). The most common symptoms were inspiratory stridor (n=16; 76%), dyspnea (n=13; 60%) and cough (n=9; 42%), (p=0.346). There was no significant relation between concurrent diseases and the frequencies of symptoms (0.091). Triggers for attacks were found to be air pollutants including dust, smoke and temperature variations (n=8; 38%), exercise (n=7; 33%), perfumes and detergents (n=6; 28%), animal fur and pollen (n=4; 19%), phonation and loud speaking (n=3; 14%) and emotional stress-anxiety (n=1; 4%), (p=0.308). Durations of attacks were several minutes in 14 patients (66%), several seconds in five patients (23%) and more than one hour in two patients (9%), (p=0.338). CONCLUSION: Durations and triggers of attacks and initial symptoms in paradoxical vocal fold movement disorder seems not to be related with concurrent laryngeal and respiratory diseases.

An unusual giant subacute necrotizing sialadenitis as an emergency case of otolaryngology.

Subacute necrotizing sialadenitis is an inflammatory necrotizing lesion occurring in minor salivary glands. Most cases occur in the palatal region. In this article, we reported a 36-year-old man referred to our clinic as an emergency with the complaints of excessive bleeding, airway obstruction and hipovolemia. Intraorally, there was a hemorrhagic, protruding giant mass in the palatal region. Following the first biopsy, which was not diagnostic, a second biopsy was performed. Histopathologic examination showed acinar cell necrosis and dense inflammation of the affected minor salivary glands in the second biopsy. The diagnosis of subacute necrotizing sialadenitis was made on the basis of clinical and histologic features of the lesion. Subacute necrotizing sialadenitis is a rare lesion, and admittance to the otolaryngology clinic as an emergency case is much rarer. To avoid unnecessary surgical intervention, it is necessary to diagnose subacute necrotizing sialadenitis correctly, which can be confused with malignant diseases of the salivary glands.

Unilateral isolated incus agenesis: detection by virtual endoscopy.

We report the first case of unilateral incus agenesis in the literature. Preoperative diagnosis by virtual endoscopy further enhances the significance of this case. We present thin-section temporal bone computed tomographic images and 3-dimensional reconstructed views which were all correlated with intraoperative findings. The patient was successfully treated with an ossicular prosthesis replacement.

[A possible cause of snoring: bilateral tortuosity of the internal carotid artery]. / Horlama nedeni olabilecek bir anomali: Internal karotis arterin iki tarafli kivrilmasi.

Tortuosity of the internal carotid artery affecting the pharyngeal wall is a rare anomaly, and bilateral tortuosity is even rarer. A 55-year-old male patient presented with a complaint of snoring. On physical examination, there was bulging and bilateral pulsation in the oropharyngeal wall, narrowing the passage and extending to the hypopharynx. Magnetic resonance angiography showed bilateral tortuosity of the internal carotid artery, which was thought to contribute to snoring.

[Surgical approach to encapsulated follicular variant of papillary thyroid carcinoma: a report of three cases]. / Tiroid papiller karsinomunun kapsüllü folliküler varyantinda cerrahi yaklasim: Uç olgu sunumu.

The diagnosis of follicular variant of thyroid papillary carcinoma is often difficult with fine-needle aspiration biopsy since this variant contains both benign and malignant follicular structures. The encapsulated follicular variant poses even more difficulty for diagnosis. It is usually agreed that this variant has similar clinical behavior to that of classic thyroid papillary carcinoma. However, some recent cases have been shown to have an aggressive course, leading to controversy as to the type of surgery. We presented three female patients whose results of fine-needle aspiration biopsy were not malignant, but postoperative histopathologic diagnosis was made as encapsulated follicular variant. One patient underwent thyroid lobectomy for a single thyroid nodule, and two patients underwent subtotal thyroidectomy. Upon histologic diagnosis of encapsulated follicular variant, total thyroidectomy was performed in two patients. Encapsulated follicular variant should be borne in mind in patients with a benign fine-needle aspiration biopsy result.