Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid change in head position, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study was to investigate and compare the effectiveness of Epley maneuver and Brand-Daroff home exercises for the treatment of posterior canal BPPV. METHODS: A total of 50 patients between 27 and 76 years of age who were diagnosed with unilateral posterior canal into BPPV were randomized prospectively into two groups. In Group-1, modified particle repositioning maneuver and in Group-2 Brandt-Daroff exercises were utilized as treatment. Patients were followed weekly. Cure weeks were recorded. The patients were followed for 12 to 24 months for recurrence. RESULTS: The recovery rates at the first, second and third week controls were 76%, 96% and 100% for Group-1 (modified Epley maneuver) and 64%, 88% and 100% for Group-2 (Brandt-Daroff exercises) respectively. The recovery rates were similar for both groups. The average follow-up duration was 18 months. In Group 1, 7 patients (28%) and in Group 2, 5 patients (20%) had recurrence, which was also similar with no statistical difference. CONCLUSION: It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers were almost equally effective in the treatment of BPPV.

Impact of Septoplasty on Eustachian Tube Functions.

OBJECTIVE: To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions. MATERIAL AND METHODS: The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months. RESULTS: Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group. CONCLUSIONS: Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.

Reconstruction of orbital exenteration defects with bilobed forehead flap.

To describe the use of bilobed forehead flap for reconstruction of orbital exenteration defect. The medical records of 2 patients in whom orbital exenteration defect repair was performed with bilobed forehead flap were reviewed. In both patients (male, ages 74 and 65 years), extended exenteration was performed because of basal cell carcinoma infiltrating the upper and lower eyelids and orbit. One patient had a history of multiple eyelid surgeries and periorbital radiotherapy. In the other, the tumor also involved the maxillary and ethmoid sinuses and nasal dorsum. The bilobed flap was combined with a cheek advancement flap in 1 patient. The excisional defect could be primarily covered in both patients. In 1 patient, a skin graft was needed to cover the forehead donor area defect. In both patients, transient, distal flap ischemia developed after surgery and, in 1 patient, eyebrow malposition required surgical correction at the late period. No other complication developed during follow-up (18 and 26 months). The bilobed forehead flap can be effectively used to reconstruct total or extended orbital exenteration defects.

Comparison of Clinical Results in Nasal Tip Augmentation Either Via Face to Face or Back to Back Technique With Autogenous Auricular Conchal Cartilage.

OBJECTIVE: To compare the objective and subjective findings between patients who underwent nasal tip augmentation surgery via two different methods using autogenous auricular conchal cartilage. MATERIALS AND METHODS: This study included the data of 21 patients who underwent nasal tip augmentation surgery. The patients were randomly divided in two groups according to the technique used to form a double layer columellar strut graft; either face to face (group 1) and back to back (group 2). All patients were assessed via nasal obstruction symptom evaluation scale (NOSE) and via acoustic rhinometry and rhinomanometry at preoperative and postoperative 1st and 6th months. RESULTS: There was statistically significant improvement in symptom score in both patient groups with no difference inbetween. Total nasal resistance decreased nonsignificantly at the end of 6th month in both groups; 13.1 Pa/cm3 to 8.6 Pa/cm3 and 10.3 Pa/cm3 to 9.5 Pa/cm3 respectively. There was no significant increment in MCA values for both groups except left MCA1. CONCLUSIONS: We achieved good results in tip augmentation via both techniques. An autogenous conchal cartilage is a good alternative to replace lacking caudal septal cartilage. It provides safe and stable support to the nasal tip. However, further comprehensive studies with larger sample size and long follow-up are required to elucidate any difference between these two techniques.

The effects of levobupivacaine infiltration on post-tonsillectomy pain relief in adults: a single-blinded, randomized, and controlled clinical study.

The aim of this prospective single-blinded and controlled study is to evaluate the efficacy of levobupivacaine infiltration on post-tonsillectomy pain relief in adults. The study was conducted with 40 adult patients who underwent tonsillectomy. These patients were randomized in either study group (SG) who received levobupivacaine infiltration to peritonsillary fossae prior to surgery or control group (CG) with no medication. After surgery, all the patients were queried for pain scores by visual analog scale. In addition, the volume of intraoperative bleeding, the duration of operation, the severity of postoperative complications, and the amount of analgesic requirement were the other outcome measures of this study. There were significant differences between groups regarding pain scores for the first 24 h in favor of SG. The analgesic requirement was also significantly lower in SG (p = 0.009). Although there was a sustained decrement at pain score during first 24 h for SG, however, the change from baseline score (immediate score) for each time interval revealed no significance compared to CG. In addition, the duration of operation and the volume of intraoperative bleeding were similar (p = 0.64 and p = 0.165). In conclusion, preincisional infiltration of levobupivacaine is a safe and reliable method for post-tonsillectomy pain reduction in adults. However, more in-depth, double-blinded and placebo controlled studies are required to elucidate its long term benefits.

An evaluation of the results of chemoradiotherapy and surgical treatment for hypopharyngeal cancer.

OBJECTIVES: This study aims to evaluate the efficacy chemoradiotherapy and surgical treatment in patients with hypopharyngeal cancer. PATIENTS AND METHODS: Between January 2003 and July 2009, 48 patients (31 males, 17 females; mean age 55.5±13.4 years; range 29 to 84 years) who were diagnosed with hypopharyngeal cancer were retrospectively evaluated. The patients were assigned into surgery (n=17) and chemoradiotherapy (n=31) groups. RESULTS: The overall survival of the patients with advanced disease in the surgery group was statistically higher than those in the chemoradiotherapy group. The recurrence rate of the patients was 35.3% in the surgery group, whereas it was 41.4% in the chemoradiotherapy group. CONCLUSION: Our study results indicated that the survival rates were higher in the surgery group. On the other hand, chemoradiotherapy had the advantage of laryngeal preservation.

The efficacy of nasal surgery in obstructive sleep apnea syndrome: a prospective clinical study.

The aim of this study was to investigate the effects of surgical intervention for nasal pathologies on obstructive sleep apnea syndrome (OSAS) and continuous positive airway pressure (CPAP) titrations in patients with OSAS. The study was designed as a prospective case control study. Between December 2007 and June 2010, 31 patients (26 men and 5 women) who were diagnosed with OSAS with polysomnography and confirmed to have obstructive nasal pathology were enrolled in the study. The average age of the patients was 53 ± 9.6 (range 33-68 years) and the body mass index ranged from 22 to 40.6 kg/m(2) with an average of 30.3 ± 4.1. The patients were evaluated with Epworth Sleepiness Scale, OSAS Complaints Questionnaire, visual analog scale, and CPAP titration before and 3 months after nasal surgery. As three patients did not attend the control polysomnography, data analysis was performed on 28 patients. Although there was a significant improvement in the nasal passage and subjective complaints, namely, snoring frequency, apnea and daytime sleepiness, the difference between preoperative and postoperative AHI values was not statistically significant. Postoperative CPAP titration results indicated a decrease both in pressures and in AHI in comparison to preoperative values. These reductions were not statistically significant, although the decrease in CPAP pressures was close to significance (p = 0.062). Nasal pathologies should be treated in all patients with OSAS, particularly those undergoing CPAP treatment. However, patients should be counseled that favorable results might not be achieved after nasal surgery.

[The role of sentinel lymph node biopsy in oral cavity cancer]. / Oral kavite kanserlerinde sentinel lenf nodu biyopsisinin rolü

OBJECTIVES: This study aims to evaluate the role of sentinel lymph node (SLN) biopsy in patients who had clinically N0 oral cavity cancer in the neck assessment. PATIENTS AND METHODS: Between May 2006 and May 2008, nine patients with clinically N0 oral cavity cancer (6 females, 3 males; mean age 57±24.7 years; range 31 to 71 years) who underwent surgical treatment were enrolled in this study. Eight of them had corpus linguae carcinoma, while one had lower lip carcinoma. Tumor stages were T1 in four, T2 in four patients, and T4a in one patient. The patients underwent surgery within 8 to 16 hours after lymphoscintigraphy was performed for detecting SLNs. Initially primary tumor was excised. Then, SLNs which were identified by a gamma probe, lifting skin flap of the neck were excised. Neck dissection was performed as scheduled. SLNs were examined in frozen sections. The results of frozen section and definitive histopathological diagnosis of SLNs were compared with each other, as well as the definitive histopathological diagnosis of the dissection materials. RESULTS: In all patients SLNs were completely identified and excised successfully, including one node in one patient, two nodes in six patients and three nodes in two patients. All nodes were localized ipsilaterally in the neck. In addition, the frozen section and definitive histopathological examination results of all nodes were consistent. Biopsy results indicated that eight patients were SLN-negative, while one was SLN-positive. Only one patient was SLN-negative, although the pathological diagnosis was found to be N1. CONCLUSION: Our study results suggests that SLN biopsy may be applicable for early stage oral cavity tumors.

Effects of levobupivacaine versus bupivacaine infiltration on postoperative analgesia in pediatric tonsillectomy patients: a randomized, double-blind, placebo-controlled study.

OBJECTIVES: We compared the effects of levobupivacaine hydrochloride, bupivacaine hydrochloride, and saline injections in alleviating posttonsillectomy pain. METHODS: Between November 2009 and April 2010, we recruited 60 patients (36 male and 24 female) between 2 and 12 years of age into the study. After informed consent was obtained from the parents, patients admitted for tonsillectomy were randomized into 3 groups by means of sealed envelopes. Group 1 (20 patients; mean age, 6.45+/-2.78 years) received 0.9% sodium chloride (saline solution), group 2 (20 patients; mean age, 5.60+/-2.70 years) received 0.25% levobupivacaine hydrochloride, and group 3 (20 patients; mean age, 5.85+/-2.43 years) received 0.5% bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated with McGrath's face scale. RESULTS: The postoperative pain scores at 1 and 5 hours were similar among the groups (p>0.05). The pain scores in the levobupivacaine group were lower than those in the saline group at 13 hours (p<0.017). The pain scores in the bupivacaine and levobupivacaine groups were significantly lower than those in the saline group from 17 to 21 hours until day 6 (p>0.017). There was no difference between the levobupivacaine and bupivacaine groups (p>0.017). CONCLUSIONS: Local infiltration of levobupivacaine is a relatively safe and effective method and is equivalent to use of bupivacaine for posttonsillectomy pain.

Communication adjustment of patients with a laryngectomy in Turkey: analysis by type of surgery and mode of speech.

Previous studies have routinely shown that individuals with a laryngectomy (IWL) have a decreased quality of life (QoL). However, the questionnaires frequently used are not specifically designed for persons with laryngeal cancer and may not reflect the issues of most concern to IWL. The purpose of this study was to investigate (1) the overall communication adjustment of IWL in Turkey, (2) the differences in communication adjustment among types of surgery for the treatment of laryngeal cancer, and (3) the differences in communication adjustment among types of speech following treatment for laryngeal cancer. Fifty-two patients (50 males and two females) who underwent surgical treatment for laryngeal cancer (i.e. total, supraglottic, frontolateral, vertical, supracricoid) and were being seen for follow-up care were recruited from an ENT clinic in Bursa, Turkey. Patients were provided with a written translation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) which yielded information on three subscales (General, Environment, and Attitude) and a Total score. Kruskall-Wallis and Wilcoxon signed ranks nonparametric tests of significance showed that overall adjustment was within the well-adjusted range for all types of surgery and modes of speech with two exceptions: Mean scores for supracricoid laryngectomy with cricohyoidopexy (28.5) and esophageal speech (29.3) were both within the poorly adjusted range on the Environment subscale [lowest mean score = 8.7 (supraglottic)]. Total mean scores ranged from 19.8 (supraglottic) to 49.9 (esophageal speech). Mean scores of the General subscale ranged from 4.0 (electrolaryngeal speech) to 7.7 (tracheoesophageal speech). Mean scores of the Attitude subscale ranged from 6.2 (supraglottic) to 19 (electrolaryngeal). Results of the Kruskall-Wallis test also showed a significant difference between type of surgery for the Environment subscale (p = 0.003), the Attitude subscale (p = 0.039), and the Total score (p = 0.007). The results suggest that overall, IWL in Turkey are well-adjusted to their new voice. However, results also showed that certain conservation surgeries (i.e. supraglottic, frontolateral, vertical) yielded more favorable outcomes than either supracricoid laryngectomy or speech following total laryngectomy. This finding is most likely related to the amount of tissue preserved following conservation surgery, in particular the preservation of the vocal folds.

[The effect of treatment of temporalis muscle fascia grafts with formaldehyde on the success rates of tympanoplasty]. / Temporal kas fasya greftlerinin formaldehit ile islenmesinin timpanoplasti basari oranlarina etkisi.

OBJECTIVES: This study aims to investigate the effect of formaldehyde treatment of temporalis muscle fascia grafts used during tympanoplasty on the postoperative success rates. PATIENTS AND METHODS: Fifty-four patients who underwent tympanoplasty between January 2006 and January 2007 in the Department of Otolaryngology, Medicine Faculty of Uludag University and who were under regular follow-up were included in this prospectively planned study and divided into two groups: the study group (n=24) and the control group (n=30). Temporal muscle fascia grafts were used in all patients. The grafts were treated with formaldehyde in the study group. All the controls of the patients were performed by otomicroscopy. Audiometric tests were performed at the 6th month controls. RESULTS: It was found out that perforation was permanently repaired in 79.2% of the study group and in 73.3% of the control group (p>0.05). We obtained an evident improvement in the average airway bone gap in both groups. We could not detect any statistical significance in the comparison of the operation duration between the groups although the operation duration in the study group was shorter (the study group: 735 seconds, the control group: 775 seconds). CONCLUSION: The formaldehyde treatment of the temporalis muscle fascial graft used in tympanoplasty was not superior in closing perforation and operation length compared to its direct dry use. However, we concluded that the graft could be more easily manipulated during the operation.

The reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome.

OBJECTIVES: This study aims to assess the reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Seventy-two patients (50 males, 22 females; mean age 51.4±11.1 years; range 20 to 74 years) with OSAS were included in this prospective, non-randomized double-blinded single cohort study between May 2008 and February 2009. Patients who underwent an attended overnight polysomnography (PSG) and consented to participate in the study were asked to use SleepStrip device within the week following PSG recording. The apnea-hypopnea index (AHI) was compared with the SleepStrip score (Sscore). RESULTS: The mean body mass index of patients was 31.1±4.3. Both AHI and Sscore were obtained in 64 patients. There was a strong correlation between Sscore and AHI (r=0.76, p<0.001). The sensitivity and specificity of the SleepStrip were 94.4% and 93.5% when used to diagnose cases with AHI = or >40. The sensitivity and specificity of the SleepStrip was reduced to 80% and 87.2% when AHI threshold was chosen as = or >25 and 83.3% and 76.5% for AHI = or >15 respectively. CONCLUSION: There is a strong correlation between SleepStrip and AHI. SleepStrip was found to be effective in diagnosing severe OSAS with AHI = or >40, however, its diagnostic capability was reduced in patients with lower AHI's who constitute the main target of screening.

The role of selective neck dissection in pathological N1 squamous cell carcinomas of the head and neck.

OBJECTIVES: This study aims to evaluate the effectiveness of selective neck dissection (SND) in stage pN1 head and neck cancers. PATIENTS AND METHODS: Patients who underwent neck dissection due to squamous cell carcinoma of oral cavity, larynx, oro-hypopharynx were evaluated retrospectively. Sixty-one patients diagnosed with pathological N1 by neck dissection were included in the study. Thirty-four of the 61 necks, to which SND was applied, comprised the study group, and 27 necks, which underwent comprehensive neck dissection (CND), comprised the control group. RESULTS: Neck recurrence rates were 4.9% for all cases, 5.9% for the SND group and 3.7% for the CND group. Two- and five-year disease-specific survival rates were similar for SND group (78.6%, 72.5%) and CND group (90.5%, 82.9%). Two- and five-year overall survival rates were also similar for SND group (67.6%, 58%) and CND group (81.5%, 66%). None of them were significantly different between groups (p>0.05). CONCLUSION: Selective neck dissection provides comparable results to CND in the treatment of pN1 necks.

Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Comparison of 3-months treatment adherence and estimating residual apnea hypopnea index between home versus in-laboratory auto-titrating positive airway pressure titration.

PURPOSE: We aimed to assess the accuracy of home titration in estimating apnea hypopnea index (AHI) and optimal pressure values and to compare improvements in subjective daytime sleepiness, sleep quality and quality of life, along with 3-months treatment adherence of patients that received at-home versus in-laboratory auto-titrating positive airway pressure (APAP) titration. MATERIALS AND METHODS: In patients with a diagnosis of obstructive sleep apnea syndrome (OSAS), a study arm of laboratory attended APAP titration was compared with a study arm of home titration using an APAP device for three days. Subjective questionnaires were evaluated before and after 3 months of treatment. RESULTS: Fifty-three patients with newly diagnosed OSAS were enrolled. There was a significant positive correlation between PSG AHI and APAP AHI (rs  = 0.43, P = 0.003) and the fixed pressure for the APAP arm was positively correlated with the APAP PSG arm of the study (rs  = 0.71, P < 0.001). When the Bland-Altman graphs were compared, it was seen that the measurements obtained by the APAP AHI method were 0.3 units higher than the PSG AHI measurements, and that the mean of the measurement differences between the two methods was not different than 0 (P [H0 : Mean = 0] = 0.551). After 3 months of treatment, average nightly use was slightly higher in the APAP arm (P = 0.387). CONCLUSIONS: The results indicate that both titration methods were not clinically inferior in terms of a fixed optimal pressure, residual events, 3-months treatment adherence and change in subjective sleepiness, sleep quality and quality of life after treatment.

Does antenatal magnesium sulphate improve hearing function in premature newborns?

Objective: To evaluate whether antenatal magnesium sulphate (MgSO4) exposure has a neuroprotective effect against hearing impairment in premature newborns. Material and Methods: Retrospective cohort study was performed with prematurely (<37 weeks) delivered newborns at a tertiary university hospital. Newborns of 92 women who received MgSO4 infusions (study group) for various indications were compared to newborns of 147 women who did not receive MgSO4 infusions (control group). All eligible premature newborn underwent hearing screening by auditory brainstem response (ABR) testing before being discharged from the hospital. Results: The fail rate for ABR hearing screening was 3.3% (n=3) in the study group and 10.9% (n=16) in the control group (p=0.034). The rate of concurrent use of betamethasone was higher in the study group (72.8%; n=67) compared to control group (29.2%; n=43) (p<0.001). Other neonatal parameters, such as the number of neonates who were small for gestational age and the rate of microcephaly were similar between the groups (p=0.54, p=0.48, respectively). After adjusting for co-variates including the use of betamethasone and gestational age at delivery, no statistically significant association between antenatal administration of MgSO4 and ABR fail rates were found (p=0.07). Conclusion: These results do not suggest a significant benefit in terms of hearing impairment in premature newborns when antenatal MgSO4 infusion was given.

Preoperative evaluation of chronic rhinosinusitis patients by conventional radiographies, computed tomography and nasal endoscopy.

OBJECTIVES: The aim of this study was to compare the efficacy of conventional radiography (CR), computed tomography (CT) and nasal endoscopy for the preoperative evaluation of chronic rhinosinusitis in patients with persistent complaints despite appropriate medical therapy. PATIENTS AND METHODS: Forty-three patients (26 males, 17 females; mean age 43 years; range 15 to 73 years) were prospectively evaluated. All patients underwent detailed physical examination, CR and coronal high resolution CT of paranasal sinuses. Thirty of them were evaluated with detailed nasal rigid and/or flexible endoscopy as well. The anatomic variations and mucosal changes in paranasal sinuses were noted. The specificity and sensitivity of CR was calculated using CT findings as a reference point. Surgery was performed on two of the other three patients because of obstructive symptoms of middle turbinate. Paradoxal middle turbinate surgery was performed on one patient due to a headache of rhinogenic origin. RESULTS: In our study 40 (93%) of all patients showed mucosal abnormalities on CT. Computed tomography scanning of the patients revealed anatomic variations in 74.4% of the cases. Mucosal pathology was most frequently observed in the anterior ethmoid region (middle meatus). While we found mucosal anomalies in 47.4% of all sinuses using CR, 42.2% of these cases were confirmed with CT. Also, 19.5% of all sinuses evaluated as normal with CR presented pathologic findings on CT. An overall correlation of 75.3% was observed between CR and CT, while diagnostic nasal endoscopy and CT findings were correlated at a rate of 87%. CONCLUSION: (i) While no ipsilateral maxillary or frontal sinus disease was detected when no abnormality in the anterior ethmoid region and infundibulum was observed endoscopically in the presence of mucosal abnormalities similar abnormalities were seen at the same side for maxillary or frontal sinuses. (ii) Anatomic variations of nasal and paranasal sinuses may be considered as etiologic and predisposing factors of chronic rhinosinusitis. (iii) Conventional radiography should not be used as a single diagnostic tool in preoperative evaluation; however, due to its high sensitivity, CR technique may be used alone in the diagnosis and follow-up of maxillary sinus disease. (iv) Nasal endoscopy may reduce unnecessary diagnostic CT scanning procedures.

Management of pain after tonsillectomy: a prospective, randomized clinical study.

OBJECTIVES: We evaluated the alleviation of post-tonsillectomy pain with systemic and topical applications. PATIENTS AND METHODS: Data obtained from 78 patients (28 females, 50 males) who had undergone tonsillectomy for recurrent tonsillitis by conventional cold surgery were reviewed with prospective, randomized clinical study. Initially, the patients were assigned into topical and systemic drug groups. These groups were then divided into three sub-groups; (i) clindamycin, dexamethasone, and control (saline) (ii) groups for the topical drug group; (iii) cefprozil, amoxicillin+clavulanate and control (no medications except analgesic) for the systemic drug group. The intensity of pain perceived by the patients at 21 different times was assessed by visual analog scale and facial scale. RESULTS: No significant relation was found between topical or systemic antibiotic use and pain intensity after tonsillectomy. CONCLUSION: Neither topical application nor systemic administration is significantly superior to the other for postoperative management of pain.

Evaluation of amylase levels in the neck drainage and serum for early diagnosis of the pharyngocutaneous fistula.

OBJECTIVES: To assess the value of amylase levels in neck drainage and serum for the diagnosis of pharyngocutaneous fistula in the early postoperative period. PATIENTS AND METHODS: We conducted a prospective study in a tertiary referral setting. Thirty-two patients (31 males, 1 female; mean age 63; range 45 to 75 years) who had laryngectomy operation as the primary treatment were studied. Amylase levels in the neck drainage and serum were analyzed in the first three postoperative days. The results were compared between patients who developed pharyngocutaneous fistula and who did not. RESULTS: Serum amylase levels were significantly higher in pharyngocutaneous fistula group, whereas amylase in the neck drainage was not diagnostic. CONCLUSION: Serum amylase levels may be used in laryngectomy patients for the early diagnosis of pharyngocutaneous fistula.

Unexpected findings in the neck dissection specimens for primary head and neck squamous cell carcinoma.

OBJECTIVES: We aimed to determine the incidence of unexpected pathological findings observed during the histopathological examination of the neck dissection specimens performed for primary head and neck squamous cell carcinoma, and their impacts on the treatment and follow-up plans. PATIENTS AND METHODS: We retrospectively reviewed 410 patients (369 males, 41 females; 169 patients unilateral, 241 patients bilateral) with a diagnosis of squamous cell carcinoma of head and neck, who underwent 651 neck dissections. RESULTS: Unexpected pathological findings were found in 3.2% of patients and 2% of neck dissections. These unexpected findings were tuberculosis in eight patients (2%), metastatic papillary thyroid carcinoma in three patients (0.7%), Warthin,s tumor in one patient and cystic hygroma in one patient. All patients who had metastatic papillary thyroid carcinoma received radioactive iodine treatment after thyroidectomy. In control examinations, none of these cases had problem related to neither primary disease nor thyroid pathology. Only two of eight patients who had tuberculosis in lymph nodes received medical treatment for tuberculosis, while the others were observed by clinical and radiological examinations. None of these patients had problems related to tuberculosis. We had no long-term follow-up results for cystic hygroma and Warthin,s tumor since these patients did not continue their routine examinations. CONCLUSION: During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. Most frequently seen unexpected findings were tuberculosis lymphadenitis and metastatic papillary thyroid carcinoma. However, these pathologic findings do not seem to affect the management of the primary disease.