Determination of cytokine profile and associated genes of the signaling pathway in HNSCC.

Head and neck squamose cell carcinoma (HNSCC) is an aggressive group of tumors that are generally heterogeneous. Despite treatment advances, disease-free survival has not significantly improved. Therefore, it is of great importance to understand the molecular etiology of HNSCC and genetic alterations in the signal pathways in order to develop new therapeutic approaches. In this study, firstly we used a cytokine array to analyze the secretomes of HNSCC patients and healthy controls. In the next step, the results from the cytokine sequence were validated by qRT-PCR and western blot, including genes in the associated signaling pathway. In array analysis, the levels of EGF, IGF-1, IGFBP-1, and PDGFBB were significantly higher in patients than in the controls. The results of qRT-PCR analyses showed that expression levels of PDGFRB gene were significantly up-regulated (p = 0.006) and PTEN (p > 0.001) were significantly down-regulated in tumors compared with normal tissues. When groups (early vs. advanced) were compared, higher expression of IGFBP-1 was observed in the larynx (p = 0.045) and larynx + oral cavity tumors (p = 0.010) in an advanced stage. In western blot analysis, pEGFR, pIGF-IR, pIR-ß, pPDGFRB, and pAKT levels were upregulated, and pPTEN was downregulated in tumors. Based on our observations, determining the interactions of EGFR, PDGFRB, IGF-1R and PTEN or the activation of each might represent a promising new and innovative treatment approach in HNSCC patients. It seems clear that, in most cancers, effective targeted therapy may be involved the blockade of each one or multiple targets.

Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study

Background/aim: This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods: This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results: In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion: Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.

Intratympanic mixture gentamicin and dexamethasone versus dexamethasone for unilateral Meniere's disease.

OBJECTIVE: This study aimed to determine the effectiveness of an intratympanic (IT) injection of a mixture of gentamicin and dexamethasone compared with intratympanic dexamethasone (ITD) for controlling vertigo and protecting the hearing level of Meniere's disease patients who have persistent vertigo attacks, despite medical treatment. METHODS: Thirty eight patients with intractable Meniere's disease were included in this study. Twenty-one patients were treated with IT mixture gentamicin and dexamethasone injection; seventeen patients were treated with ITD. Pre- and post-treatment audiograms were compared with pure-tone averages. Control of vertigo was classified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) vertigo control index. RESULTS: In the mixture group single IT injection was administered in 18 patients (85.7%), 2 injections were administered in 2 patients (9.5%) and 3 injections were administered in one patient (4.8%). In the ITD group IT injection was performed 3 times (days 1,3,5) at intervals. The mean number of intervals per patient was 3,41 (range 1-6). Two years after IT treatment there was better control of vertigo in mixture group than in ITD group; 81% of mixture group and 70,6% of the ITD group achieved satisfactory control of vertigo (p = 0,0286). Audiology results of mixture group showed 20 patients (95,24%) with unchanged hearing and 1 patient (4,76%) with only 10-decibel deteriorated hearing. There was no worsening of hearing in the ITD group. CONCLUSION: The results of this study showed that an IT injection of a mixture of gentamicin and dexamethasone in intractable Meniere's disease cases is more effective than ITD for vertigo control.

Comparison of the effects of the temperature of intratympanic dexamethasone injections on vertigo.

OBJECTIVE: This study aimed to compare if vertigo improved in patients when the dexamethasone used in the intratympanic (IT) injection was applied at body temperature or at room temperature. METHODS: The study included 54 patients who had undergone intratympanic treatment due to sudden hearing loss and tinnitus. The IT injection was administered to all patients, 2 times with 1-day intervals. Two different IT injection techniques were used for each patient: injecting dexamethasone at room temperature and injecting it at body temperature. Patients were asked to report the vertigo they felt immediately, and at 15 min after the injection using the visual analogue scale (VAS) and the four-point categorical rating scale (CRS-4). RESULTS: The level of vertigo immediately after injection was lower when the dexamethasone was injected at body temperature rather that at room temperature for both the VAS and CRS-4 (p < 0.05). However, no statistical differences in the VAS and CRS-4 self-report values between the two methods were found 15 min after the injection (p > 0.05). CONCLUSION: Vertigo due to IT decreases within minutes. When the IT drugs are administered at body temperature, temporal vertigo due to injection is lower than when they are administered at room temperature.

Evaluation of upper esophageal sphincter in benign vocal lesions.

PURPOSE: To evaluate upper esophageal sphincter (UES) activity in patients with benign glottic lesions. METHODS: Twenty-three patients with benign vocal fold (VF) lesions scheduled for manometric evaluation were enrolled as the study group (SG); 20 healthy subjects without vocal pathology or dysphagia were included as the control group (CG). UES residual, basal, relaxation time and peak pharyngeal pressures were evaluated by manometry. The reflux symptom index (RSI) and reflux finding score (RFS) were used to estimate the clinical findings of laryngopharyngeal reflux, and the voice handicap index (VHI) was measured in both groups. The patients' data were compared using the Mann-Whitney test and t test. RESULTS: The diagnoses in the SG were vocal nodules, vocal polyps, vocal cysts, sulcus vocalis, or Reinke's edema. The evaluation scores (RSI, RFS, and VHI) were significantly higher in the SG than in the CG (P < 0.05). UES basal and relaxation pressures, relaxation time, and peak pharyngeal pressures did not differ between the SG and the CG (P > 0.05). CONCLUSION: UES manometric pressure was similar in patients with VF mucosal lesions and controls. Studies involving larger populations are necessary to confirm the manometric changes in the UES and to elucidate the pathogenesis of benign VF lesions.

Conchae Bullosis in a Pediatric Patient.

Pneumatization of the turbinates called concha bullosa is one of the most frequent anatomic variations of the nasal cavity. We report the first case of computed tomography findings of bilateral middle and inferior concha bullosa in a 13-year-old child with nasal obstruction. Here we describe a patient with extreme bilateral bullosa of inferior and middle conchas, as well as crista galli. The patient was treated successfully with endoscopic surgery of conchas. Nasal obstruction secondary to a bilateral turbinate bullosis in a child has not been described before. The clinicians should take this entity into consideration when evaluating the pediatric patients with nasal obstruction.

Esophageal Stricture in a Child With Habit of Acidic Drinks.

A 12-year-old boy with Down syndrome referred to the authors' department with dysphagia and growth retardation. Dysphagia was especially with solid foods and had a 12-month history. When he was 7, he had started to drink Coke and from that time he had a Coke drinking habit. Every day he was drinking more than 2 L Coke and was eating meals in small amounts. Investigations of the patient revealed esophageal stricture related to acidic drink habit and gastro-oesephageal reflux. The patient was treated with recurrent bouginage, antireflux medication, and nutrional support. The patient became symptom free from 13 months and gained weight. The clinicians should take the nutrition habits into consideration when evaluating the esophageal stricture patients.

Surgical Management of Dysphagia Due to Anterior Cervical Osteophytes.

PURPOSE: The present study was performed to share personal experiences and to discuss the advantages and disadvantages of anterior cervical osteophytes surgical procedures. METHODS: The operative records of anterior cervical osteophytes patients who did not benefit from conventional treatments and underwent osteophytectomy were analyzed retrospectively. Transoral and transcervical anterolateral methods were applied, considering both the localization of the osteophyte and the patient's preference. RESULTS: Five patients were operated with the transcervical anterolateral method, and 3 patients were operated with the transoral procedure. Those using the transcervical method were likely to encounter complications, however, being comfortable for patients. Although the transoral procedure is much safer, the patients may face postoperative pain, long healing time, and morbidities as hematoma, cervical instability, and infection after surgery. CONCLUSIONS: Both transcervical and transoral methods will improve the functional swallowing pathologies and decrease aspiration-penetration. Transoral approach is not recommended due to slow healing times and postoperative pain, although it creates easier access to the spine.

Foreign Body of Submandibular Gland.

Obstructive adenitis is common disorder of submandibular gland. Sialolithiasis is the most common etiologic factor causing obstruction. If a sialolith is not detected, chronic obstruction of salivary glands is called nonspecific sialoadenitis. Foreign body-associated sialoadenitis of submandibular gland is very rare within the literature. In this study, the authors presented a patient having an unrecognized foreign body in the submandibular gland beside the duct that was causing chronic sialoadenitis. Foreign bodies must be explored and all suspected areas must be examined carefully for avoiding secondary problems and surgeries in the future.

Permanent Quadriplegia Following Replacement of Voice Prosthesis.

The authors presented a patient with quadriplegia caused by cervical spine abscess following voice prosthesis replacement. The authors present the first reported permanent quadriplegia patient caused by voice prosthesis replacement. The authors wanted to emphasize that life-threatening complications may be faced during the replacement of voice prosthesis. Care should be taken during the replacement of voice prosthesis and if some problems have been faced during the procedure patients must be followed closely.

Noninvasive Treatment of Acquired Subglottic Stenosis.

A 23-day-old infant referred to the neonatal intensive care unit with difficulty breathing and inspiratory stridor increasing with exercise. Medical history included a cardiothoracic surgery for transposition of the great arteries, patent ductus arteriosus, atrial septal defect, and a history of intensive care unit from surgery. Flexible fiberoptic transnasal laryngoscopy revealed subglottic stenosis that was probably caused by prolonged intubation with a higher airway pressure. Computed tomographic scan of the neck showed a tiny stenosis without cartilage deformity and limited in subglottic region. Tracheotomy and external open surgery was found risky for sternal wound infection or mediastinitis as the neonate had newly thoracotomy. The patient had a balloon dilation under general anesthesia without intubation. Presenting symptoms of the neonate were fully improved with balloon dilation.

Simultaneous transsphenoidal and transventricular endoscopic approaches for giant pituitary adenoma with hydrocephalus.

The surgical management of giant pituitary adenomas is challenging. Although most pituitary adenomas, even those with suprasellar extension, can be resected using the transsphenoidal surgery alone, the transcranial approach is still needed for approximately 1% to 4% of these tumors. The transcranial approach is usually used in large adenomas with hourglass configuration and adenomas with firm consistency impeding the adjunctive measures, which are used for delivering the suprasellar part of the tumor into the sellar area and thereby obscure the tumor resection by transsphenoidal route. In this report, we describe the successful use of transventricular endoscope as an adjunctive measure to remove giant pituitary adenoma from transsphenoidal route and discuss the limitations of this new technique. We concluded that this technique would be used safely in selected cases. Case selection and surgical strategies should be based on preoperative magnetic resonance imaging findings, ventricular size, and the availability of experienced surgeons.

An evaluation of the effects of adenoidectomy on voice and speech function in children.

OBJECTIVES: This study aims to evaluate the possible effects of adenoidectomy on voice and speech function. PATIENTS AND METHODS: Thirty-six children (20 boys, 16 girls; mean age 8.22±1.86 years) with adenoid hypertrophy and 50 healthy children (23 boys, 27 girls; mean age 8.54±1.92 years) were included in the study. Acoustic and spectrographic analyses, voice analysis and nasalance assessment were carried out preoperatively and at one week and three months postoperatively in children who underwent adenoidectomy operation and control group. RESULTS: A significant change in voice nasalance and F3 and F4 formants was observed in children who underwent adenoidectomy. There was no significant change in F0, shimmer %, amplitude perturbation quotient (APQ), jitter %, relative average perturbation (RAP), noise to harmonic ratio (NHR), F1 and F2 formant values, as assessed by objective voice analysis. CONCLUSION: Our study results show that adenoidectomy may affect voice resonance and nasalance, changing the shape and size of nasopharynx and upper respiratory tract. Adenoidectomy seems to be safe without any significant change in the voice quality.

Transcanal Endoscopic Management of Middle Ear Paragangliomas.

OBJECTIVE: To evaluate the clinical and audiological outcomes of transcanal endoscopic resection of middle ear paragangliomas. STUDY DESIGN: Retrospective multicenter study. SETTING: Tertiary referral center and private otology clinic. PATIENTS: Patients who underwent transcanal endoscopic surgery between January 2015 and September 2020. INTERVENTIONS: Transcanal endocope-assisted resection of middle ear paragangliomas. MAIN OUTCOME MEASURES: Demographic data. RESULTS: Twenty-three patients (2 men, 21 women) with a mean (standard deviation [SD]) age of 50.5 (11.8) years and stage 1 or 2 disease were included in the study. The mean follow-up time was 2.7 years (range, 1-5 yr). Preoperatively, the mean (SD) air-conduction threshold was 33.8 (17.9) dB, and the mean (SD) air-bone gap was 13.1 (13.9) dB. Postoperatively, the mean (SD) air-conduction threshold was 25.7 (10.2) dB, the mean (SD) air-bone gap was 6.3 (6.1) dB. The mean (SD) hospital stay was 27.7 (9.9) hours. No tumor regrowth was detected on magnetic resonance imaging during postoperative follow-up. CONCLUSIONS: Endoscopic transcanal tumor resection is effective and feasible in the treatment of stage 1 and 2 tumors and is associated with short operative time, low risk of perioperative and postoperative complications, and rapid discharge.

Giant ethmoido-orbital osteoma presenting with dacryocystitis and metamorphopsia.

Osteoma is the most common benign neoplasm of the paranasal sinuses. Intraorbital extension is rare. Here we report a 16-year-old adolescent boy who presented with epiphora and pain in the medial canthal area. A computed tomographic scan revealed a bone density mass in the left ethmoid cavity extending into the adjacent orbit. The tumor was removed via endoscopic endonasal surgery. The pathologic evaluation was consistent with osteoma. After surgery, all complaints have been resolved and there was not any sign of recurrence in the computed tomographic scan.

[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.

Histopathological Evaluation of Platelet-Rich Plasma Effect in Acute Tympanic Membrane Perforation.

Platelet-rich plasma (PRP) is a reliable and has low side-effect profile and has beneficial effects on wound healing. Its investigatory effects on wound-healing process were shown on various tissues. This study aims to investigate PRP's local application effects to perforated rat TM in terms of healing and histopatological outcomes. Twenty-two Wistar rats were used in the study. The rats' ears were examined with a pediatric endoscope (2.7 mm, 0°), and the TM posterior quadrant of their right ear was perforated with a 20-gauge needle. After this procedure, the rats were divided into two equal groups. A spongel with PRP was applied on the perforated TM in the first group, and spongel with standard saline solution was applied on the second group. Following the sacrifice, the middle air bullas were carefully dissected and removed for histopathological examination. Hematoxylin eosin (for fibroblasts, lymphocyte, collagen fibers) and immunohistochemical staining were done for epithelial growth factor receptor (EGFR), fibroblast growth factor receptor (FGFR1), and vascular endothelial growth factor (VEGF) staining for histopathologic examinations. There was not a significant difference between the two groups for lymphocyte. There was a significant difference between control and study groups for collagen and EGFR (P < 0.05). Although the mean value of FGF- and VEGF-positive cells was higher in the study group than in the control group, the difference was not significant (P > 0.05). PRP is an effective autologous material for the healing process of acute TM perforations in a rat model, as demonstrated in the present study. We think that the use of PRP for acute TM perforations can have a positive effect on the healing process by increasing the level of growth factors, especially EGFR. In addition, an increase in collagen can also have a positive effect on healing. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-021-02912-2.

Effect of swallowing rehabilitation using traditional therapy, kinesiology taping and neuromuscular electrical stimulation on dysphagia in post-stroke patients: A randomized clinical trial.

OBJECTIVE: We aimed to evaluate the functional recovery of stroke patients with orophyaryngeal dysphagia after treatment with traditional swallowing therapy (TST), neuromuscular electrical stimulation (NMES), and kinesiology taping (KT), by using clinical swallowing assessments and objective fiberoptic endoscopic evaluation of swallowing (FEES). METHODS: A total of 37 patients were randomized in three groups: those who received TST and NMES as Group 1 (n:12), those who received both TST and KT as Group 2 (n:13), and those who received TST, NMES, and KT together as Group 3 (n:12). Patients were evaluated before treatment, after treatment, and three months after treatment onset with bedside water-swallow test, Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), penetration-aspiration scale (PAS), and National Institute of Health-Swallow Safety Scale (NIH-SSS). FOIS, PAS, and NIS-SSS were completed according to results of fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS: A statistically significant decrease was observed in bedside water-swallow test, EAT-10, PAS, and NIH-SSS scores in all treatment groups 5 weeks and 3 months after treatment onset compared to pre-treatment scores (p < 0.05). There was a statistically significant increase in FOIS scores 5 weeks and 3 months after treatment compared to pretreatment scores in all treatment groups (p < 0.05). When the pre-treatment, 3-week, and 5-month swallow scale scores of all groups were compared, there was no significant different difference in terms of bedside water-swallow test, EAT-10, FOIS, PAS, or NIH-SSS scores (p > 0.05). CONCLUSION: According to the results of our study, KT is a new option in the treatment of stroke-related dysphagia, is an effective treatment approach and its efficacy is maintained throughout long-term follow-up.

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.