[Tularemia in Konya region, Turkey]. / Konya Bölgesinde Tularemi.

Tularemia is a zoonotic infection caused by Francisella tularensis. In the recent years tularemia has become a re-emerging infection in Turkey with epidemics and also sporadic cases. Transmission occurs most often through consumption of contaminated water and food, direct contact with animals and insect/ tick bites. In this study, we evaluated clinical features and laboratory findings of 35 tularemia cases diagnosed during two outbreaks that occurred in two different villages during two different periods in Konya (located in Central Anatolia), Turkey and five sporadic cases. In both outbreaks, first (index) cases were admitted to our outpatient clinic with the complaints of cervical lympadenopathy. After diagnosis of tularemia, an organized team visited the villages to search if more cases existed. For microbiological diagnosis, blood, throat and tonsil swabs and lymph node aspirate specimens were collected from the suspected cases. Diagnostic tests (culture, serology, molecular methods) for tularemia were performed in reference center, Refik Saydam National Public Health Agency. Drinking and potable water samples from those villages were also collected by provincial health authorities. The cases (n= 14) that belonged to the first epidemics were detected in February 2010 and cases (n= 21) of the second epidemics in November- December 2010; five cases were followed as sporadic. The mean age of the 40 patients (25 females, 15 males) was 37.6 (age range: 5-80 years; five of them were pediatric group) years. The most common complaints of patients were cervical mass (90%), sore throat (63%), chills (60%) and fever (58%). The most frequently detected clinical findings were enlarged lymph nodes (n= 34, 85%), followed by tonsillitis (20%), skin lesions (15%) and conjunctivitis (8%). Most of the patients (82.5%) had been misdignosed as acute tonsillitis, suppurative lymphadenitis, tuberculous lymphadenitis and brucellosis, before their admission to our hospital and treated with beta-lactam antibiotics. Demographic analysis of the cases revealed that 68% of them lived in the rural area, 75% had rodents at home, 46% used natural water supplies, 53% fed animals, 15% had contact with game animals and 5% had contact with ticks. Clinical samples from the patients were found culture negative for F.tularensis. The diagnosis of the cases was based on the presence of specific F.tularensis antibodies between 1/160-1/1280 titers obtained by microagglutination test. Additionally F.tularensis DNA was demonstrated in three lymph node aspirate samples by polymerase chain reaction (PCR). Water samples were found negative both by culture and PCR assays. However, it was detected that there were problems in the chlorination of water supplies in the two villages where epidemics were seen. All the patients were treated with streptomycin (2 x 1 g, intramuscular, 10 days), and surgical intervention was performed for the patients (n= 12) with extremely large lymph nodes and suppuration. Erythema nodosum developed in two patients following the end of treatment. Death or serious complications such as pneumonia or meningitis were not detected. In conclusion, tularemia should be considered in patients presenting with cervical lymphadenopathy, sore throat, fever and unresponsive to previous treatment with beta-lactam antibiotics. For the management of the disease, healthcare personnel and the community should be educated concerning the risk factors and precautions for tularemia.

New validation of a well-known marker in cochlear implant infections: A retrospective, case-controlled, observational study.

Objectives: Cochlear implant (CI) infection is the most common complication after CI surgery. We investigated whether the preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) values could predict the CI infection and the NLR and PLR values obtained at the first admission to the hospital with an CI infection could help the clinician in the diagnosis. Methods: This retrospective case-controlled study included 26 patients with postsurgical CI infection. To prevent age-related incompatibility in the blood analysis of the infected group, the patients were divided into three age groups: 0-4 years, 5-18 years, and over 18 years old. To compare the infected group, 29 patients who did not have implant infection after CI surgery and whose age ranges were compatible with the infected group were randomly selected from the hospital records as the control group. The infected group preimplantation (PREs) and postinfection (POSTi) NLR and PLR values were compared with each other and the control group values. The area under the curve, sensitivity, specificity, and cutoff values were calculated by ROC analysis. Results: The POSTi NLR values of the infected group patients aged 0-4 years and over 18 years were significantly greater than the PREs NLR values (p = .038 and p = .008, respectively). Significant differences were found between the POSTi NLR values of the infected group patients aged 0-4 years and over 18 years and those of PREs in the control group (p = .011 and p = .015, respectively). Conclusions: Preoperative NLR and PLR values cannot predict postoperative CI infection. However, NLR and PLR values increased significantly after CI infection, even if systemic symptoms did not occur. At the first admission to the hospital, NLR values can guide the clinician in diagnosing the CI infection in patients between 0 and 4 years and over 18 years.Trial Registration Clinical Trials.gov Identifier: NCT04120181.

Extracapsular dissection versus superficial parotidectomy in pleomorphic adenomas of the parotid gland.

OBJECTIVES: We aimed to compare the results of extracapsullary dissection (ED) with superficial parotidectomy (SP) in the surgical treatment of benign parotid tumors. PATIENTS AND METHODS: Forty-one patients who were diagnosed with pleomorphic adenoma of the parotid gland and underwent surgery between January 1992 and June 2000 were enrolled in this study. The patients were divided into two groups: the ED group (6 males, 15 females; mean age 47.2 years; range 32 to 57 years) and the SP group (7 males, 13 females; mean age 47.7 years; range 29 to 61 years). ED was performed on 21 patients and SP was performed on 20 patients. All patients were followed-up postoperatively and the mean follow-up time was 194 (range 117 to 264) months. RESULTS: Although no complications developed in the ED group patients during the follow-up period, there were several cases in the SP group: three cases of salivary fistula, one of Frey's syndrome, three case of temporary facial paresis and 13 of cosmetic deformity. The cosmetic deformities were as minimal depressions in the parotid region. There have been no recurrences in either group. There was a statistically significant difference between the two groups regarding cosmetic deformity (p=0.000 and X2=19.27). There was also a statistically significant difference between the two groups regarding general complications (p=0.001 and X2Y: 8.32). CONCLUSION: Extracapsullary dissection is a safe and reliable surgical procedure compared to superficial parotidectomy with a lower complication rate and a similiar recurrence rate.

Effect of Hypertonic Saline during Flexible Nasopharyngeal Laryngoscopy: A Double-Blinded, Randomized, Controlled Trial.

OBJECTIVES: Flexible nasopharyngeal laryngoscopy (NPL) is a cost-effective, simple procedure that provides visualization of the nasal airways. However, it involves a number of challenges for both the clinician and the patient. Hypertonic saline nasal wash is used to prevent nasal secretion in acute/chronic sinusitis and after nasal surgery. We aimed to determine the efficacy of hypertonic saline by comparing the clinician's and patients' experiences during NPL. METHODS: This prospective, double-blinded, randomized, controlled study was performed at a tertiary referral university hospital. Two hundred patients were randomly divided into hypertonic saline, lidocaine, xylometazoline, and isotonic saline groups. During NPL, the clinician's experiences in terms of the quality of the field of view and the patients' experiences in terms of pain and discomfort resulting from the 4 premedication drugs were compared. RESULTS: The groups differed significantly in terms of the clinician's field of view, and patients' pain scores and levels of discomfort (P < 0.025). The field of view results were the highest in the hypertonic saline group, and the lowest in the lidocaine group. The pain scores were the lowest in the lidocaine group, whereas they were the highest in the hypertonic saline group. The discomfort scores were the lowest in the xylometazoline group, but the highest in the lidocaine and isotonic saline groups. CONCLUSION: The use of hypertonic saline facilitated the NPL procedure by improving the clinician's field of view. Moreover, intranasal hypertonic saline reduced the patient's discomfort. Intranasal hypertonic saline can be a good alternative to premedication before NPL.

Comparative effects of α lipoic acid and melatonin on cisplatin-induced neurotoxicity.

Cisplatin is a carcinogenic agent having important cytotoxic effects. Cisplatin treatment increases the levels of free oxygen radicals in neurologic tissues. We investigated the effects of alpha lipoic acid (ALA) and melatonin (MEL) on the electrophysiological parameters and on activities of nerve fibers having different conduction properties on cisplatin neurotoxicity. Neurotoxicity was induced by a single injection of 10 mg/kg intraperitoneal (ip) cisplatin. Supplementation was started 1 day before cisplatin injection with either 100 mg/kg/day ip ALA or 4 mg/kg/day ip MEL for 7 days. Compound action potentials were recorded from isolated sciatic nerves in vitro, and numerical analyses were conducted. Cisplatin-induced neurotoxicity resulted in a significant decrease (p <.05) in maximum depolarization (mV), areas (mV·ms), and maximum and minimum upstroke velocity values (mV/ms). Although these decrements were restored by ALA and MEL, ALA was found to be more effective. Conventional conduction velocity measurements and conduction velocity distribution histograms have shown that ALA supplementation can recover the effects of cisplatin while MEL cannot. The conduction velocity distribution histograms have shown that antioxidant supplementation results in a restoration on contribution of fast-conducting fibers (51.8-77.7 m/s), which is deteriorated by cisplatin. Consequently, ALA has more potential to make up for the deleterious effects of cisplatin-induced neurotoxicity.

Reconstruction of large nasal septal perforations with a three layer galeal pericranial flap: an anatomical and technical study.

OBJECTIVES: In this study, a modified surgical method was carried out to repair large nasal septal perforations with a galeal pericranial flap using endoscopic technique. MATERIALS AND METHODS: Six adult human cadavers were dissected by applying the classic open rhinoplasty technique. Large perforations were created in the septal cartilages. To repair the perforations, we prepared galeal pericranial flaps with supraorbital neurovascular pedicles and calvarial bone grafts under endoscopic visualization. The flaps were inserted between the upper lateral cartilages and folded into three layers. The flaps were sutured to the nasal mucosa with absorbable sutures. The length, the width, the size of the flaps and the perforations were measured using an electronic caliper and a flexible ruler. RESULTS: The mean length and width of the flap pedicles were measured as 26.8±5.1 mm (range 20 to 32 mm) and 19.3±2.6 mm (range 15 to 23 mm), respectively. In addition, the mean length and the width of the flaps were 54.1±4.9 mm (range 50 to 60 mm) and 51.6±7.8 mm (range 45 to 63 mm), respectively. All of the nasal septal perforations were repaired with a galeal pericranial flap. CONCLUSION: The galeal-pericranial flap is well-vascularized and similar to the nasal mucosa for tissue thickness. Therefore, reconstruction with galeal-pericranial flaps can be an alternative surgical technique for repair of large nasal septal perforations.

[Frontal sinus obliteration with pericranial-subgaleal flap]. / Perikraniyal-subgaleal flep ile frontal sinüs obliterasyonu.

OBJECTIVES: We evaluated the results of patients who underwent frontal sinus obliteration with vascularized pericranial-subgaleal flap. PATIENTS AND METHODS: Charts of patients (7 males 1 female; mean age 40.5+/-17.1 years; range 9 to 61 years) who underwent frontal sinus obliteration with pericranial-subgaleal flap between June 2001 and January 2008 were retrospectively reviewed. Demographics, indications for frontal sinus obliteration, immediate and late postoperative complications were recorded. All patients were invited to the clinic and underwent control examinations and computed tomography. The indications for frontal sinus obliteration were fracture of frontal sinus anterior and posterior walls in four cases, frontal sinus mucoceles in two cases, mucopyoceles in one case and fracture of frontal sinus anterior wall in one case. Bicoronal incision was used in all patients and then they underwent frontal sinus obliteration with lateraly based pericranial-subgaleal flap. RESULTS: In the postoperative period rhinorrhea and meningitis, which lasted for two days, developed in one patient with fracture of frontal sinus anterior-posterior walls and hypoestesia developed in the frontal skin area in one patient with fracture of frontal sinus anterior wall. No complications were observed in the other cases. CONCLUSION: Pericranial-subgaleal flap is a well vascularized, close to surgical area, inexpensive, safe and effective tissue that can be used for frontal sinus obliteration.

The medial wall of the jugular foramen: a temporal bone anatomic study.

OBJECTIVE: To better understand the variable and complex anatomy of the jugular foramen (JF) and the relationship between the neurovascular structures in the medial wall of the jugular bulb (JB). STUDY DESIGN: A temporal bone anatomic study. SETTING: A temporal bone laboratory within a hearing research facility. SUBJECTS AND METHODS: Twenty-two temporal bones were dissected under the operating microscope. The JF anatomy was exposed by using the modified infratemporal fossa approach (no rerouting of the facial nerve). Pictures were taken at various intervals during the dissection. Distances between important structures were measured with two-point calipers and transferred to a millimetric scale. RESULTS: The right JF was found to be larger than the left side in 72.7 percent of the dissected temporal bones. A fibrous septum separated the glossopharyngeal (CN IX) from the vagus (CN X) and accessory (CN XI) nerves in 19 specimens (86.4%), and a complete bony septum was present in three specimens (13.6%). The CNs IX, X, and XI traveled anteromedially to the JB within the JF. The inferior petrosal sinus (IPS) drained into the medial wall of the JB at various locations by two or more channels. In most of the specimens (86.4%), the IPS separated CNs IX and X. CONCLUSION: The lower cranial nerves have an intimate relationship to the medial wall of the JB. Within the JF, the neurovascular structures vary in size, shape, and location. To minimize surgical morbidity, the surgeon should be familiar with the complex anatomy of the JB and its variations.

Evaluation of HLA-A, -B, -Cw, and -DRB1 alleles frequency in Turkish patients with nasal polyposis.

OBJECTIVE: To evaluate whether there is a relationship between HLA-A, -B, -Cw, and -DRB1 alleles and developing nasal polyposis (NP). STUDY DESIGN: Data from 66 patients with NP were compared with data from 100 healthy randomly selected controls. Asthma, ASA (acetylsalicylic acid) triad, polyp score, and previous sinonasal surgery were also recorded. SUBJECTS AND METHODS: Genotyping of the HLA-A, -B, -Cw, and -DRB1 alleles were performed with polymerase chain reaction (PCR) with the sequence-specific primer (SSP) method. Data were analyzed by using a Pearson chi(2) test. RESULTS: The HLA-B*07 and -Cw*12 alleles were found to be significantly higher in the NP patients compared with the control group, whereas the HLA-B*57 and HLA-Cw*04 alleles were significantly lower (P < 0.05). The HLA-A*24, HLA-Cw*12, and HLA-DRB1*04 alleles were determined to be significantly higher in the NP patients with asthma and ASA triad (P < 0.05). CONCLUSIONS: Our results show that some of the HLA alleles seem to be associated with the genetic susceptibility to develop NP in the Turkish population.

The morphometric development of the fetal larynx during the fetal period.

OBJECTIVE: The aim of the present study was to investigate morphometric growth patterns of the cartilaginous components and vocal cords in human fetal larynx. METHODS: This study was performed in the Anatomy Department of Meram Medicine Faculty in 2007. The fetuses were obtained from the Gynaecology Department of the Meram Medicine Faculty of Selcuk University, and Dr. Faruk Sükan Maternity Hospital (Konya, Turkey). Forty spontaneously aborted fetuses (25 males and 15 females) without detectable malformations were evaluated. The dimensions of the larynx and its cartilaginous components were measured and the relationship between the obtained data was statistically assessed with Student's t-test. RESULTS: Correlations were found between the cartilaginous components, size of the larynx, and gestational age. No gender differences were identified. The anatomical variations in the epiglottis cartilage dimensions and types were found in 15% of cases. The foramen thyroideum was observed in 12.5% of cases. CONCLUSION: The data of this study may contribute to the knowledge of the fetal larynx regarding laryngomalacia.

A case of concha bullosa pyocele.

A 12-year-old girl presented with complaints of unilateral nasal obstruction, headache, snoring, and nasal discharge of a two-year history. Physical and nasal endoscopic examination revealed a large lesion obliterating completely the left nasal cavity. A diagnosis of concha bullosa pyocele was made by computed tomography and biopsy. Subtotal resection of the left middle turbinate by endoscopic approach was performed, which resulted in adequate nasal passage and drainage of the pyocele.

Evaluation of c-MYC status in primary acquired cholesteatoma by using fluorescence in situ hybridization technique.

OBJECTIVE: The object of study was to investigate the status of c-MYC oncogene in primary acquired cholesteatoma. STUDY DESIGN: Descriptive study. METHODS: Cholesteatoma samples were obtained from 15 patients with primary acquired cholesteatoma during surgical operation. Fluorescence in situ hybridization with a mixed DNA probe, which is specific for c-MYC located on 8q24 and chromosome 8 specific-alpha-satellite DNA probe (dual color), was used on the interphase nuclei. RESULTS: Copy number of c-MYC oncogene and aneuploidy of chromosome 8 were 21.2% +/- 14.4% and 21.7% +/- 14.8%, respectively. There was no significant difference between copy number of c-MYC and frequency of chromosome 8 aneuploidy (p > 0.05). Ten of 15 cases showed different percentage of c-MYC and chromosome 8 aneuploidy, whereas 5 (33.3%) of 15 cases showed a normal distribution of c-MYC and chromosome 8 signals. CONCLUSION: The copy number of c-MYC in 10 of 15 cases was found to be high as observed for chromosome 8 aneuploidy in primary acquired cholesteatoma. These findings suggest that the ability of hyperproliferation of primary acquired cholesteatoma might have been related to c-MYC copy number by deregulating c-MYC expression.

Anterior atticoantrostomy for cholesteatoma surgery.

OBJECTIVES: We aimed to investigate the long-term results of anterior atticoantrostomy in adult patients with cholesteatoma. METHODS: A total of 83 ears in 78 patients were operated on by the anterior atticoantrostomy technique, supported by a periosteal flap, between 1991 and 2002. RESULTS: Cholesteatoma recurred in only 4 ears (4.8%). In the 79 ears without recurrence, re-perforation was observed in 3 ears (3.8%), and retraction pockets developed in the attic of 5 ears (6.3%), 2 of which needed ventilation tubes. Absorption or migration of cartilage grafts was not seen in any of the patients. The mean air-bone gap was 34.8 +/- 13.4 dB and 16.9 +/- 14.7 dB, and the mean high-tone bone conduction was 19.0 +/- 6.2 dB and 21.1 +/- 6.6 dB, in the preoperative and postoperative periods, respectively. CONCLUSIONS: In the reconstruction of the posterior canal wall, a cartilage graft supported by a periosteal flap prevents attic retraction and may increase the vascularization of the graft. After anterior atticoantrostomy, the recurrence rate and the probability of leaving residual tissue are low. Therefore, we believe that anterior atticoantrostomy is a relatively safe and effective technique that can be used in the management of cholesteatoma.

Tympanoplasty in pediatric patients.

OBJECTIVE: The aim of this study is to analyze the clinical features and follow-up of a series of pediatric patients with chronic otitis media undergoing tymponaplasty surgery and to identify the effect of the factors on the course. METHODS: Forty-one children (mean age 15.1+/-2.62 years, range from 8 to 16 years) who had undergone tympanoplasty with or without ossicular reconstruction were evaluated. Age, gender, size and site of perforation, status of operated ear (dry/discharging), status of the contralateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels, average postoperative follow-up time, and postoperative complications were recorded. RESULTS: Myringoplasty in 28 patients (68.3%), incus interposition in 7 patients (17.1%), partial ossicular replacement prostheses in 4 patients (9.7%) and total ossicular replacement prostheses in 2 patients (4.9%) were performed. In the 37 (90.2%) of patients, intact graft was determined during postoperative follow-up. Surgical success including intact graft and postoperative air-bone gap of less than 25 dB were obtained in 34 (82.9%) cases. CONCLUSIONS: The present study suggested that tympanoplasty was a quite successful method in the appropriate pediatric patients between the ages of 8 and 16 years. In the preoperative evaluation for surgery success, some factors, such as dry middle ear, healthy contralateral ear and concordant to postoperative care should be considered.

Effectiveness of MeroGel hyaluronic acid on tympanic membrane perforations.

CONCLUSIONS: Our results support the proposition that hyaluronic acid (HA) provides a moist wound-healing environment to aid in the healing process of tympanic membrane perforation. A single MeroGel administration can be effective as well as daily topical HA application in the treatment of tympanic membrane perforations. A single application of esterified HA may be more suitable for patients and also for otolaryngologists. OBJECTIVE: The purpose of the present study was to evaluate the effectiveness of a single MeroGel application on traumatic tympanic membrane perforations in rats. MATERIALS AND METHODS: The posterior quadrant of the tympanic membranes in both ears of 24 male pathogen-free Sprague-Dawley rats was perforated with a 20-gauge needle. Subjects were divided into two groups: MeroGel and daily topical HA-treated groups. All subjects were sacrificed and histopathological examinations of the tympanic bullas were carried out. RESULTS: Perforations of controls, and MeroGel- and daily HA-treated groups closed in 17/24 (70.8%), 11/12 (91.7%), and 12/12 (100%) ears, respectively. There was a significant difference between control and MeroGel-treated groups, and also between control and daily topical HA-treated groups for the presence of vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), lymphocytes and collagen fibrils (p<0.05), whereas there was no significant difference between MeroGel- and daily topical HA-treated groups (p>0.05).

[Treatment options and common problems in patients with maxillofacial trauma]. / Maksillofasiyal travmali hastalarda tedavi seçenekleri ve karsilasilan sorunlar.

BACKGROUND: The approach and type of management along with the common complications in maxillofacial trauma were evaluated in this study. METHODS: Medical records of 602 patients (486 males; 116 females; mean age 28,4+/-15,2; range 1 to 80 years) with maxillofacial fractures, admitted to the Department of Otolaryngology between 1992 and 2004, were evaluated in this study. Maxillofacial fracture was diagnosed by clinical and radiological findings. Sex and age distribution of patients, etiology of trauma, localization of the fractures, treatment modalities, time to treatment after the trauma and postoperative complications were recorded. RESULTS: There were 257 (42,7%) mandible, 156 (25,9%) nose, 66 (11%) maxillary, 34 (5,6%) zygoma, 32 (5,3%) multiple facial, 29 (4,8%) blow-out and 28 (4,7%) frontal sinus fractures. While 256 (43%) patients underwent closed reduction, 346 (57%) patients were treated by open reduction. Postoperative complications were seen in 8,3% (51) of patients. CONCLUSION: Although associated with some complications, open reduction and miniplate fixation should be the preferred treatment option, since it provides a powerful fixation, is easy to perform, and has better esthetic and cosmetic results.

[Foley balloon placement for maxillofacial fractures]. / Maksillofasiyal kiriklarda foley kateter balonunun kullanimi.

OBJECTIVES: The aim of the study was to evaluate the effectiveness of maxillary sinus Foley balloon placement in patients with maxillofacial fractures. PATIENTS AND METHODS: This study included 38 patients (10 females, 28 males; mean age 29.1+/-11.6; range 9 to 49 years) in whom Foley balloon placement and gauze packing were performed for blow-out, orbitozygomatic, or maxillary fractures. Sex and age distributions, etiology of trauma, localization of fractures, management, intraoperative and postoperative complications were evaluated. RESULTS: Eighteen patients had blow-out fractures, 15 patients had orbitozygomatic fractures, and five patients had Le Fort II-III fractures of the maxilla. Preoperatively, enophthalmos, diplopia, limited ocular motility, and facial asymmetry were found in 28.9%, 26.3%,18.4% and 65.8%, respectively. Sufficient maxillary sinus patency was obtained in 32 patients (84.2%). Enophthalmos, diplopia, limited ocular motility, and facial asymmetry were found in 13.2%, 7.9%, 5.3%, and 18.4% in the postoperative period, respectively. CONCLUSION: Maxillary Foley balloon placement should be preferred in the blow-out, orbitozygomatic, and maxillary fractures because it supports the orbital floor and provides sufficient maxillary sinus patency.

[Petrous bone lesions]. / Petröz kemik lezyonlari

OBJECTIVES: We evaluated the results of treatment and follow-up of patients with petrous bone lesions. PATIENTS AND METHODS: We retrospectively evaluated 13 patients (5 females, 8 males; mean age 33.8+/-17.4 years; range 4.5 to 65 years) who were treated and followed-up for petrous bone lesions between 1990 and 2004. The diagnoses were cholesterol granuloma (n=2; 15.4%), chondrosarcoma (n=1; 7.7%), and cholesteatoma (n=10; 76.9%). RESULTS: Patients with cholesterol granuloma had complaints of cephalgia and diplopia while those with cholesteatoma complained of otorrhea and hearing loss. One patient with cholesterol granuloma and eight patients with cholesteatoma underwent surgical operations with the use of middle skull base approach (n=1), transcochlear approach (n=2), translabyrinthine approach (n=1), and tympanopetrosectomy (n=5). Two cases with congenital cholesteatoma and one patient with cholesterol granuloma refused surgical intervention and were only followed-up. CONCLUSION: Besides surgical intervention, follow-up by computed tomography or magnetic resonance imaging may be considered in patients with incidental petrous bone lesions, presenting with limited symptoms.

Frequency of pharyngeal reflux in children with adenoid hyperplasia.

OBJECTIVES: The purpose of the study is to investigate whether there is any association between pharyngeal reflux and adenoid hyperplasia by using 24-h esophageal pH monitoring with a dual probe in children. METHODS: The study group consisted of 30 children with adenoid hyperplasia, and the control group consisted of 12 healthy children, studied prospectively. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring). The results were evaluated by the Measurement and Analysis Software of Medical Measurement System program (Version: 7.2a). RESULTS: In the study group, the frequency of pharyngeal reflux was 46.7% and the gastroesophageal reflux (GER) was 64.5%, while, in the control group, they were 8.3% and 25%, respectively. There was a significant difference between study and control groups for frequencies of pharyngeal reflux and GER. Mean adenoid nasopharyngeal ratio (ANR) was 0.78+/-0.11 in children with adenoid hyperplasia. There was not a significant difference between positive pharyngeal reflux, positive GER and mean ANR (p>0.05). CONCLUSIONS: Children with adenoid hyperplasia had higher frequency of pharyngeal reflux than children at the same age healthy group. These results supported that pharyngeal reflux may play an important role in the etiology of adenoid hyperplasia.

Pharyngeal reflux in children with chronic otitis media with effusion.

OBJECTIVE: To investigate whether there is an association between chronic otitis media (COM) with effusion and pharyngeal reflux in children by using 24-h pH monitoring with a dual probe. MATERIAL AND METHODS: This was a prospective study. The study group consisted of 25 children with COM with effusion and the control group comprised 12 healthy children. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring). RESULTS: In the study group, the frequencies of pharyngeal and gastroesophageal reflux (GER) were 48% and 64%, respectively, and the corresponding values in the control group were 8.3% and 25%. Both of these differences were significant (p <0.05). In the study group, 28% of patients were positive for at least 1 symptom of GER; 72% of the patients did not have any symptoms but 56% of these patients had silent GER. CONCLUSIONS: These findings indicate that pharyngeal reflux may play an important role in the etiology of COM with effusion. If patients have typical symptoms of GER, such as pyrosis, regurgitation, dysphagia and emesis, the presence of GER should be considered. The presence of silent GER and pharyngeal reflux should also be considered.