The Effect of Plaster of Paris on Reliabilities of RUST and mRUST Scoring Systems.

PURPOSE OF THE STUDY The aim of our study is to investigate the reliabilities of the radiographic union score for tibial fracture (RUST) and modified RUST scoring systems in the evaluation of fracture healing in adult tibia fractures treated with intramedullary nailing and pediatric tibia fractures treated with closed reduction and cast immobilization and to compare the reliabilities between two groups. MATERIAL AND METHODS Between January 2016 and January 2020, the informations of patients (ages of 4-10) with tibia fractures treated with closed reduction and casting and patients (aged 18-65 years) with tibia fractures treated with intramedullary nailing were analyzed retrospectively. Forty-seven good quality AP and lateral radiographs (represent different healing stages) each for pediatric and adult fracture groups were selected and were included in two PPTs separately. The radiographs were assessed twice with an interval of three weeks by an observer group consisting of four senior orthopedic surgeons and four orthopedic residents, and fractures were evaluated according to the RUST and mRUST scoring systems. RESULTS The inter-observer agreement of RUST and mRUST were 'perfect' in adult tibia fractures and 'substantial' in pediatric tibia fractures in both evaluations. However, in deciding fracture consolidation, inter-observer agreement was found to be 'perfect' in pediatric tibia fractures, while it was 'substantial' in adult fractures in both assessments. The mean intra-observer reliability of RUST system in adult tibia fractures was 0.860 (0.674-0.968) and 0.818 (0.693-0.909) in pediatric tibia fractures, respectively. The mean intra-observer agreement of mRUST system was 0.842(0.745-0.979) in adult fractures and 0.857 (0.756-0.932) in pediatric fractures, respectively. The mean intra-observer reliability of decision on union was 0.842 (0.638-1.000) in adult fractures and 0.785 (0.611-0.977) in pediatric fractures, respectively. DISCUSSION The decision of union in tibia shaft fractures is based on repeated clinical and radiological evaluations but there are no universally accepted guidelines to evaluate radiographic union. It has been shown in previous studies that the RUST and mRUST scoring systems can be used safely in the evaluation of fracture healing in adult patients with tibia fracture treated with intra-medullary nailing. To our knowledge, there are no studies investigating the reliability of RUST and mRUST systems in conservatively treated pediatric tibial fractures. We hypothesized that the plaster of Paris makes it difficult to assess fracture union on direct radiographs and reduce the reliabilities of these scoring systems in pediatric tibial fractures. CONCLUSIONS Our study showed that both RUST and mRUST scoring systems are useful tools that can be used safely assessing fracture healing in both pediatric and adult tibia fractures. The presence of a plaster of Paris on the extremity did not adversely affect the inter-observer and intra-observer agreement of the RUST and mRUST scoring systems. Key words: pediatric tibia fracture, radiographic union score for tibial fracture (RUST), modified RUST, radiographic union, reliability.

Improvement in quality of life by adenotonsillectomy in children with adenotonsillar disease.

OBJECTIVES: To evaluate the effect of adenotonsillectomy on quality of life of children with adenotonsillar disease and to evaluate the basal differences and post-surgical changes of life quality in children with different disease severity. STUDY DESIGN: Prospective, case - controlled study. SETTING: Tertiary referral center. PARTICIPANTS AND MAIN OUTCOME MEASURES: Preoperative and postoperative quality of life of 40 children with adenotonsillar disease were determined by pedsQL™, and disease severity was assessed in terms of a score obtained by tonsil and adenoid health status instrument (TAHSI). These children comprised the study group. Median of scores of study group was 31. Twenty-one children with a score less than 31 comprised the study subgroup I, while 19 children with a score bigger than 31 comprised the study subgroup II. Thirty normal children comprised the control group. Comparisons of data obtained from affected and healthy children and their parents were made. RESULTS: The mean preoperative physical, emotional, social, school and total quality of life scores of the study group were 64.81, 49.62, 76.37, 66.62 and 64.41; postoperatively 83.67, 75.75, 85.75, 87.25, 83.18; and control group were 82.21, 77.50, 92.50, 90.50, 85.40, respectively. There was highly statistically significant difference between all preoperative and postoperative scores of the study group. There was highly statistically significant difference between all preoperative scores of the study and control group. There was no statistically significant difference in preoperative and postoperative scores between the study subgroups. The improvement after surgery was not statistically significant between mild and severe group except for emotional scale. CONCLUSION: Children with adenotonsillar disease showed significant improvements in disease-specific and global quality of life after adenotonsillectomy as measured by TAHSI and PedsQL. Preoperative and postoperative life quality does not differ according to severity of the disease. The improvement provided by adenotonsillectomy in the children with mild disease is statistically not different from the severely affected children in overall life quality.

Intracranial cholesteatoma - case report and critical review.

OBJECTIVE: Chronic otitis media is a potentially serious disease because of its complications, most of which are common in conjunction with cholesteatomas. There is variance in the terminology used by neurosurgeons, otorhinolaryngologists and neuropathologists. Synonyms for cholesteatoma found in the literature include epidermoid tumor, epidermoid cysts and epithelial inclusion cyst. Intracranial extension of an acquired cholesteatoma is a rarely documented occurrence. PATIENTS/MATERIAL AND METHODS: A 47-year-old woman who had undergone a right tympanomastoidectomy 20 years previously, presented with a long history of mild headaches that had become progressively more severe over the last 3 years. Clinical and radiological evaluation of the patient raised the suspicion of an intracranial cholesteatoma. RESULTS: A right temporal craniotomy was performed. The mass was completely excised and histopathological study revealed the tumor to be a cholesteatoma. The patient's post-operative recovery was uneventful. CONCLUSIONS: Cholesteatomas possess the capacity for eroding bone and can have an insidious onset, but once established, grows relentlessly and destroys neighboring structures. Since a gradual intracranial involvement does not usually cause acute symptoms of increased intracranial pressure, the correct diagnosis may be difficult. Detailed clinical and radiographic studies in particular are diagnostically helpful. Because of the high incidence of delayed recurrence, life-long follow-up is required. The inconsistency in the histopathological classification of intracranial cholesteatomas should be clarified.

Nasopharyngeal aerobic bacterial flora and Staphylococcus aureus nasal carriage in deaf children.

OBJECTIVE: To determine the nasopharyngeal aerobic bacterial flora and Staphylococcus aureus nasal carriage in deaf children and the role of flora in deafness. STUDY DESIGN: A prospective, controlled study. METHODS: Nasopharyngeal and nasal swabs were collected from 87 deaf children with acquired etiology at Zonguldak primary school for the deaf and 56 healthy children. The children with genetic base (syndromic or nonsyndromic, familial or sporadic, AD, AR or X-linked recessive), and also with the history of drug exposure, head trauma, birth trauma, prematurity, hyperbilirubinemia and the viral diseases with high fever (like mumps and measles) were excluded from the study. Swabs were inoculated on to a variety of bacteriological culture media, which were then incubated in an appropriate atmosphere. Colonisation of Group A beta hemolytic streptococcus, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria menengitidis, Moraxella catarrhalis and S. aureus in upper respiratory tract were investigated. Antimicrobial susceptibility testing of the isolates were determined according to National committee for clinical laboratory standards (NCCLS) guidelines. RESULTS: Although, the rates of colonization of the nasopharyngeal aerobic bacteria and nasal S. aureus did not differ significantly between deaf children and normal healthy subjects, less colonization rates were found in deaf children than normal healthy subjects. S. aureus was isolated from 18 (20.7%) deaf children. All S. aureus isolates from deaf children were susceptible to oxacillin. Penicillin susceptibility rate was 22.2%. CONCLUSION: It is considered that nasopharyngeal and nasal colonizations of deaf children with potentially pathogenic aerobic bacterial flora is not a significant risk factor for acquired infections when compared with healthy children.

Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?

OBJECTIVE: To evaluate the efficacy of lidocaine with adrenaline on post-operative morbidity in pediatric patients after tonsillectomy. STUDY DESIGN: A double blind prospective randomized controlled clinical study. METHODS: The study is consisting of two groups of pediatric patients following tonsillectomy performed in a university hospital. One group received lidocaine with adrenaline soaked swabs packed in their tonsillar fossae while the control group received saline-soaked swabs. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. p<0.05 was accepted as statistically significant. RESULTS: No significant pain-relieving effect was seen in the lidocaine with adrenaline group (p>0.05) and also the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (p>0.05). There were no complications associated with lidocaine and adrenaline. CONCLUSION: We suggest that application of topical lidocaine with adrenaline seems to be a safe and easy medication for local anesthetic use. However, in our study, lidocaine with adrenaline offered no advantage over placebo in the control of post-operative pain and other morbidity related factors following pediatric tonsillectomy. We therefore do not recommend topical application of lidocaine with adrenaline for reducing morbidity in pediatric tonsil surgery.

Unusual case of laryngeal tumor (capillary hemangioma) obturating the larynx.

OBJECTIVES: Capillary hemangioma isolated to the free edge of the vocal fold is a rare clinical finding. We see many young patients, mostly infants under a year, who are having surgical intervention for laryngeal hemangiomas. A rapid proliferative phase occurs during the first 9 to 12 months of life; this followed by an involution phase that may be completed by 3 to 5 years of age, but can last up to 12 years. MATERIAL AND METHODS: We report the case of a 15-year-old boy who had hoarseness for a two-year related to a laryngeal mass which growth pattern was unknown. RESULTS: On endoscopic examination a polypoid mass, which was diagnosed as a capillary hemangioma later, appeared on the left vocal fold. The lesion was excised with cold-knife instrumentation by using mini-flap technique. CONCLUSION: The clinical and histopathological features and therapeutic options are discussed.

Is aspiration necessary before tympanostomy tube insertion?

Aspiration of middle ear fluid after myringotomy is performed routinely, although investigators imply a cause-and-effect relationship between suction noise and acoustic trauma. This prospective randomized study investigated if aspiration was necessary. Fifty-one myringotomies and 50 tympanostomy tube insertions were performed on 27 patients. A suction instrument was utilized in 24 ears and was not used in 27 ears. In a follow-up period, no difference was observed between the two groups. The authors did not establish that aspiration is indeed harmful, but tympanostomy tube insertion can be performed without suctioning middle ear effusion.

Can post-adenotonsillectomy morbidity be reduced by intravenous 24 h hydration in pediatric patients following adenotonsillectomy?

OBJECTIVE: To determine the benefit of 24 h intravenous hydration for pediatric postoperative adenotonsillectomy patients. STUDY DESIGN: A prospective, randomized controlled clinical study. METHODS: The study is consisting of two groups of pediatric patients following adenotonsillectomy performed in a university hospital. One group received 24 h IV hydration at hospital while the other did not have IV hydration. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. P < 0.05 was accepted as statistically significant. RESULTS: Although the postoperative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (P > 0.05), a significant pain-relieving effect was seen in hydration group after the second day (P < 0.05). There were no complications associated with intravenous hydration. CONCLUSION: Results of the current study suggest that 24 h IV hydration can reduce postoperative pain in late postoperative period following adenotonsillectomy in children but does not offer much advantage over without IV hydration therapy based on a number of other parameters. Furthermore, it seems to be cost effective, safe and easy and even these are encouraging for further studies in the future.

Pneumatization of the concha inferior as a cause of nasal obstruction.

Chronic nasal obstruction is a common disorder. Hypertrophy of the inferior turbinates is responsible for nasal obstruction more frequently than it is commonly thought. A pneumatized inferior turbinate has recently been described as a cause for nasal obstruction and only two cases have been reported until now. Inferior nasal turbinate develops by endochondral ossification of components of the mesethmoid and ectethmoid. The chondral framework of the inferior turbinate consists of a double lamella and two separate ossification centers that develop between the fifth and seventh month of fetal life. The separate ossification centers meet by the eighth fetal month. During ossification, the inferior turbinate detaches from the ectethmoid and becomes an independent bony structure. During that time the epithelium may misinvaginate into double lamellas and such double lamellas formed by the inferior turbinate may become persistent. A patient was referred to our clinic with headaches and nasal obstruction. A CT scan was performed which showed that the right lower concha was pneumatized. The headache of the patient disappeared after partial resection of the lower and middle turbinate.

The effect of peritonsillar corticosteroid infiltration in tonsillectomy.

A prospective, randomized, double-blind, placebo-control clinical study was performed to determine the effects of peritonsillar infiltration of dexamethasone on peroperative and postoperative morbidity in patients undergoing tonsillectomy with local anesthesia. A total of fifty-two patients, aged 14-34, were randomized to infiltrate dexamethasone (0.5 mg/kg, maximum dose, 12 mg) or placebo with local anesthetic at the peritonsillar region. Incidence of postoperative complications, pain medications, appetite, oral intake (type of diet) and fever were also compared between the two groups. Demographics of dexamethasone and placebo groups were similar. No statistically significant differences were noted peroperative procedures, postoperative complications, pain medication, appetite, oral intake (type of diet) between the two groups of patients.

Body growth in relation to tonsillar enlargement.

Severe airway obstruction caused by tonsillar enlargement can result in disturbances in body growth. In this study, 1136 children between 7 and 12 years of age, were evaluated and the size of their tonsils was investigated with regard to height and weight. This study was performed in the course of school screening, and correlation between estimated tonsil size and height and weight of the children was sought. Statistically, no such correlation was found (P > 0.05).

Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery.

Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Haller's cells) in 6%, spheno-ethmoid cells (Onodi's cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.

The efficacy of topical ciprofloxacin in the treatment of chronic suppurative otitis media.

We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients (95 ears) with otorrhea due to chronic suppurative otitis media in two treatment settings. One group (n = 40; 47 ears) received daily ciprofloxacin therapy plus aspiration in the clinic. The other group (n = 40; 48 ears) self-administered ciprofloxacin at home. Overall, otorrhea resolved in 88% of all ears within 12 days of the initiation of treatment. The clinic-treated patients tended to respond more rapidly than did the self-treated patients, but there was no statistically significant difference in success rates between the two groups. Side effects were negligible. We conclude that empiric topical ciprofloxacin therapy is an effective, safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media.

Gastroesophageal reflux disease and tympanoplasty surgical outcome: is there a relationship?

OBJECTIVE: To investigate the possible clinical relationship between gastroesophageal reflux disease and the type one tympanoplasty surgical outcomes of adults with chronic otitis media, by using a simple, cost-effective, reliable questionnaire and physical findings. METHODS: Fifty-two of 147 patients undergoing type one tympanoplasty were studied. Gastroesophageal reflux disease symptoms were evaluated using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease questionnaire. Laryngoscopic physical findings of laryngopharyngeal reflux were evaluated using the Reflux Finding Score. A successful outcome was defined as an intact tympanic membrane. Correlations between the two assessment tool results and the patient's surgical success were calculated. RESULTS: The gastroesophageal reflux disease questionnaire score was significantly higher in patients with unsuccessful tympanic membrane closure (group one) than in patients with successful closure (group two) (p < 0.05). The Reflux Finding Score was also significantly higher in group one than group two (p < 0.05). There was a significant positive relationship between the gastroesophageal reflux disease questionnaire score and the Reflux Finding Score (p < 0.01). CONCLUSION: Gastroesophageal reflux disease may be a significant prognostic factor for tympanoplasty failure. Therefore, reflux investigation may be important during the treatment of chronic otitis media, and positive cases may need reflux treatment as well as ear disease treatment.

Laryngocoele as an unusual complication of supracricoid partial laryngectomy: evaluation of 62 cases.

BACKGROUND: This study sought to evaluate the incidence, aetiology, clinical features and treatment modalities for laryngocoele formation after supracricoid partial laryngectomy. METHODS: The medical charts of 62 patients who had undergone supracricoid partial laryngectomy were reviewed. RESULTS: Three patients developed laryngocoele, giving an incidence of 4.8 per cent. Two of these patients presented with a cervical mass, dyspnoea and fever. The mobility of the arytenoids was disturbed on the involved side. The third patient was admitted complaining only of a compressible cervical mass. In all patients, diagnosis was made by computed tomography scan. The transcervical surgical approach was preferred for resection. CONCLUSION: Laryngocoele can occur as a late complication of supracricoid partial laryngectomy. Remnants of the laryngeal ventricle may be the cause of laryngocoele formation. The integrity of the laryngeal ventricle in the resected specimen should be routinely checked in order to avoid this rare complication. Clinicians should be aware that, following supracricoid partial laryngectomy, a cervical mass presenting with dyspnoea and disturbance of arytenoid mobility does not always indicate tumour recurrence.

Effect of nasolacrimal duct obstruction on nasal mucociliary transport.

BACKGROUND: Most patients with nasolacrimal duct obstruction have dry, crusty nasal mucosa. Mucociliary clearance is modulated by the amount and biochemical composition of nasal mucus. Nasolacrimal duct obstruction disturbs the drainage of tears into the nasal cavity. OBJECTIVE: We examined the effect of nasolacrimal duct obstruction on the mucociliary transport of nasal mucosa, by comparing saccharine test results for epiphora patients versus healthy volunteers. STUDY DESIGN: Prospective, randomised, clinical trial. METHODS: Eight patients with bilateral epiphora and 10 patients with unilateral epiphora were included in the study group. Complete nasolacrimal duct obstruction was demonstrated by studying irrigation of the nasolacrimal system, and by fluorescein dye study. The control group comprised 20 healthy volunteers. Mucociliary transport was assessed by the saccharine test in both the study and control groups. The saccharine transit times of 26 impaired nasal cavities were compared with those of 20 healthy nasal cavities of controls. Also, the saccharine transit times of the healthy nasal cavities of the 10 patients with unilateral epiphora were compared with those of their diseased sides, and also with those of healthy volunteers. RESULTS: The saccharine transit times of the epiphora patients were statistically significantly greater than those of the control group. Also, there was a statistically significant difference in saccharine transit times, comparing the healthy and impaired nasal cavities of patients with unilateral epiphora. CONCLUSION: Nasolacrimal duct obstruction has a negative effect on nasal mucociliary clearance. This may be related to changes in the amount and biochemical composition of nasal mucus.