The correlations between dynamic contrast enhanced magnetic resonance imaging and immunohistochemical data in head and neck squamous cell carcinomas.

BACKGROUND: Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) can in vivo characterize tumor microvascular environment. The aim of the present study was to reveal the DCE-MRI findings and to determine the correlation between these findings and immunohistochemical data in head and neck squamous cell carcinoma (HNSCC). METHODS: Thirty-three patients diagnosed with primary HNSCC were evaluated retrospectively. DCE-MRI was conducted in all cases. CD34, CD105, and ki-67 expressions were analyzed with immunohistochemistry in tissue sections to determine micro-vessel density and proliferative activity. RESULTS: The DCE-MRI is a successful technique in distinguishing tumor tissue from normal tissue. It was determined that Ve, Ktrans, and ki-67 values were significantly higher in high-stage tumors and there were positive correlations between the Ktrans value (by standard ROI) and CD34 MVDmax and CD34 MVDmean values. No statistically significant correlation was determined between other parameters in DCE-MRI and immunohistochemical data, and T stage. DISCUSSION: DCE-MRI could successfully differentiate tumor tissue in HNSCC. Furthermore, it was observed that DCE-MRI had the potential to reveal certain immunohistochemical information in vivo.

Tumor deposits in salivary gland tumors.

Tumor deposits (TDs), identified in different types of carcinomas are associated with poor prognosis. Salivary gland tumors were evaluated for the first time for TDs in this series. Pathological and clinical features of 25 salivary gland carcinomas primarily treated surgically including neck dissection were determined and all cases were evaluated for TDs in dissection specimens. Seven patients (28%) had TDs. There was no difference for TDs when histological type, tumor grade, tumor localization, pT, pN stage, surgical margin, lymphovascular, perineural invasion, local recurrence, distant metastatic disease and overall survival were considered. Disease-free survival rates at 12 and 24 months were 52.5%, 28.6% and 73.3%, 57.1%, for cases with and without TDs (P = 0.463). Overall survival rates at 12 and 24 months for these groups were 85.7% and 57.1 versus 86.7% and 66.7% respectively (P = 0.916). Mean estimated recurrence-free survival time for all cases, TD negative and TD positive cases were: 171.86, 182.72 and 82.42 months, respectively. Mean estimated overall survival time for these groups were 175.80, 186.489 and 89.70 months, respectively. TDs were described in salivary gland tumors for the first time in this series and seem to be associated with poor prognosis requiring further evaluation in larger series.

Assessing Olfactory Function in Parkinson's Disease via Entropy Analysis of Chemosensory Event Related Potentials.

The relationship between Parkinson's disease (PD) and olfactory dysfunction has been investigated via psychophysical and electrophysiological assessments. Despite the increasing number of electrophysiological studies focusing on olfactory function, there are still some limitations to observe the chemosensory event-related potentials (CSERP), which are electrophysiological responses of the brain to olfactory and trigeminal stimulations, because of the low sensitivity (low signal-to-noise ratio). Recent studies attempted to establish new techniques to increase the sensitivity for evaluating the CSERP and brain responsiveness. We aimed to inspect CSERP via entropy analysis in assessing chemosensory related brain responses that has been used for the first time. Twelve newly diagnosed and non-medicated PD patients and 12 healthy subjects participated in the study. Psychophysical and electrophysiological evaluation of olfaction were assessed via Sniffin' Sticks Test (SST) and entropy analysis on CSERP in three time windows. The scores of odor threshold, odor identification and total scores of SST were lower (hyposmic) in PD patients compared to healthy subjects. Electrophysiological assessments revealed a significant change in entropy among time windows for olfactory stimulation with phenyl ethyl alcohol and trigeminal stimulation with carbon dioxide (both p < 0.05) in healthy subjects but not in PD patients. Entropy findings indicate that the brain operates in ordered state among healthy subjects in response to olfactory/trigeminal stimuli, whereas the PD patients displayed a chaotic pattern. This pattern in the PD patients suggests the lack of proper smell function. It should be studied if this pattern can be used as a biomarker for PD.

[Primary intraosseous squamous cell carcinoma of the mandible]. / Alt çenenin primer intraosseöz yassi hücreli karsinomu.

Primary intraosseous squamous cell carcinoma is an extremely rare tumor of the mandible. The diagnosis is based on the evidences showing that the tumor is neither originated from a distant metastasis of another primary tumor nor an invasive oral cancer. In this article, we report a 59-year-old female case with a medical history of ductal carcinoma of the breast, lichen planus, and rheumatoid arthritis who was admitted with complaints of a painful and swollen left lower jaw, and was surgically treated for primary intraosseous carcinoma of the mandible and with postoperative adjuvant radiotherapy.

[Analysis and publication rate of the presentations at the Turkish National Otorhinolaryngology and Head and Neck Surgery meetings]. / Türk Ulusal Kulak Burun Bogaz ve Bas Boyun Cerrahisi Kongre bildirilerinin analizi ve yayimlanma oranlari

OBJECTIVES: This study aims to evaluate the analysis and publication rates of presentations presented at the Turkish National Otorhinolaryngology and Head & Neck Surgery (TNORL and HNS) meetings. MATERIALS AND METHODS: The TNORL and HNS meetings of 2008, 2009 and 2010 were included in the study. The number, subjects, types (clinical study, experimental study, case report) and institutions of the oral presentations and posters were documented using the abstract CD's of the meetings. The conversion rate of presentations into the full-text articles in the peer-reviewed journals were reviewed through the search engines Pubmed for the international indexes and Türk Medline and Ulakbim for the national ones. The time from presentation in the meetings to publication was determined. The distribution of journals according to the publication dates of the articles were evaluated in terms of the Science citation index (SCI), SCI expanded (SCI-E), PubMed and Turkish citation index. RESULTS: The total number of presentations submitted in the three TNORL and HNS meetings was 1,454 and posters accounted for 75.4% of all presentations. While case reports were 53.2% of the total presentations, the ratios were found to be 43% and 3.8% for the research and experimental studies, respectively. Of the oral presentations, 88% included research studies, whereas 70.3% of the posters were case reports. The origin of the presentations was university hospitals, education hospitals, other national institutions, and international institutions with ratios of 51.6%, 44.3%, 3% and 1.1%, respectively. The conversion rate of presentations into the full-text articles was found as 21.9%. The rate was 37.3% for oral presentations and 17% for the posters (p=0.00). For all of the 319 published papers, the overall mean time from presentation to publication was 18.6 months. While 62.7% of the articles were published in international journals, 37.3% were published in national journals. The conversion rate of oral presentations into publications was higher than the posters (p=0.00). CONCLUSION: The first study related to TNORL and HNS meetings in Turkey revealed that, although the quantity of presentations was high, the rate of conversion into the full-text journal articles was lower compared to the similar international annual meetings held by otorhinolaryngology or other disciplines. The quality and success of our scientific meetings can be enhanced with some particular precautions.

Epistaxis management: is medical intervention required for inactive epistaxis?

OBJECTIVES: This study aims to discuss the management and the follow-up approach in patients with epistaxis. PATIENTS AND METHODS: A total of 367 patients with epistaxis (209 males, 158 females; mean age 52.6±18.3 years; range 18 to 85 years) admitted to the Adult Emergency Department of a university hospital between January 2000 and December 2004 were retrospectively analyzed. RESULTS: Of patients, 56.7% had an idiopathic bleeding. A significantly higher number of patients aged >50 years had high blood pressure on admission. Of 141 patients (38.49%) presenting without bleeding on admission, 20 required medical intervention for recurrent epistaxis. Conservative approaches were effective in stopping bleeding in 97.8% patients. The hospitalization ratio was 5.7%. CONCLUSION: Our study result show that endonasal endoscopic mucosal cauterization is an effective method for resistant-to-treatment cases and inactive bleeding on admission is not a restraint for further examination.

Intramasseteric solitary fibrous tumor.

Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that usually arises from the pleura. SFTs occurring within the head and neck region are uncommon. Recently, it has been described in various head and neck sites such as oral cavity, nasal cavity, paranasal sinuses, salivary glands, thyroid, buccal space, and larynx. Here, we report a case of SFT originating in the masseter muscle of a 27-year-old woman. To our knowledge, this is the first description of a SFT of the head and neck region, arising within the masseter muscle. We present the clinical history, radiologic and histopathologic findings as well as immunoreactivity of this tumor.

[Quantitative and qualitative analysis of four national otorhinolaryngology journals between 2002 and 2010]. / Dört ulusal KBB dergisinin 2002/2010 yillari arasindaki niceliksel ve niteliksel analizi.

OBJECTIVES: This study aims to perform a quantitative and qualitative analysis of four national peer-reviewed otorhinolaryngology journals between 2002 and 2010 and compare various parameters in 1990-1994 period. MATERIALS AND METHODS: The number of authors and female authors, gender of first author, city and the institution where the article was submitted, number of references and national references were noted separately for each article in all issues of four national peer-reviewed journals in years 2002, 2005 and 2010. Language of articles was noted and they were grouped under six main headings based on their subjects. Quantitative analysis was performed considering evidence-based medicine principle and evidence levels of articles were noted between 1 and 5. Statistical analysis was performed using Pearson chi-square and one-way ANOVA tests. RESULTS: A total of 424 articles including 143 in 2002, 147 in 2005 and 134 in 2010 in four national otorhinolaryngology journals were evaluated. The number of authors per article was found to be 4.49, indicating no statistically significant difference between the years (p>0.05). The mean number of female authors per article was 0.85. When the institutions submitted articles were assessed, number of publications from university hospitals was higher than the education hospitals and other health care services; however, this difference was reduced in 2010. In the evaluation of cited references, the mean number of references and national references per article increased from 16.90 to 18.12 and from 1.54 to 1.68 in 2002 and 2010, respectively. According to the articles categorized to their main subjects, it was found that most of the publications were related to upper respiratory/digestive tract and neck and the least was related to facial plastic surgery. The qualitative analysis in terms of evidence-based medicine revealed no articles with level 1 evidence through three years studied. CONCLUSION: It will be useful to make similar periodical studies to improve the quality of otorhinolaryngology journals and related articles in Turkey.

Evaluation of Thyroidectomy Results Performed at a Tertiary Academic Center.

Objective: The aim of the study was to retrospectively analyze the patients who underwent thyroidectomy at a tertiary academic center regarding their surgical indications, histopathological diagnosis, and surgical complications. Methods: The study included a total of 739 consecutive patients who underwent lobectomy, total thyroidectomy, or completion thyroidectomy performed under intraoperative nerve monitoring (IONM) at the Department of Otorhinolaryngology-Head and Neck Surgery of Dokuz Eylül University between January 2009 and December 2019. Demographic data of the patients, preoperative clinicopathological characteristics, postoperative complications, characteristics of surgery and histopathological results were evaluated. Results: There were 619 patients in the primary surgery and 120 patients in the revision surgery groups. Indications for surgery were suspicion of malignancy in 486, multinodular goiter in 214, and hyperthyroidism in 39 patients. Final histopathological evaluation of specimens revealed malignancy in a total of 507 (68.6%) patients. Rates of transient and permanent hypocalcemia were 7.3% (54/739) and 2.2% (16/739) in the whole group, while this was 6.6% (41/619) and 1.5% (9/619), respectively, among primary total thyroidectomy patients. There were 61 (8.3%) patients with transient recurrent laryngeal nerve (RLN) paralysis (unilateral in 60 patients, bilateral in one patient) and five (0.7%) patients with permanent unilateral RLN paralysis as postoperative complications. Rates for postoperative hematoma, seroma, wound infection and chylous fistula were 2.2%, 3.7%, 0.1%, and 0.5%, respectively. Conclusion: Our results support the safety of thyroid surgery performed under IONM in tertiary academic centers. Every institution should document and share its own results to properly inform its patients preoperatively.

Evaluation of left ventricular diastolic function according to new criteria and determinants in acromegaly.

Left ventricular diastolic dysfunction (LVDD) develops in the early stages of acromegaly. The purpose of this study was to identify LVDD analyzing by new echocardiograpic criteria as well as to evaluate determinants of the LVDD in acromegaly. This cross-sectional study examined 42 patients with acromegaly; 16 in active disease (AA) and 26 cured/ well controlled (CA), and compared them with 30 healthy controls (CG). Ventricular systolic and diastolic functions were studied by conventional and tissue Doppler imaging based on the E/Em ratio and myocardial performance index (MPI). Other clinical parameters possibly contributing to LVDD in acromegaly were also investigated. The prevalence of LV hypertrophy (33%) and LVDD (35.7%) were increased in acromegaly, however, there were no differences between the AA and CA groups. Acromegalic patients had higher LV volumes and LV mass, and septal E/Em ratio compared to CG, whereas LV ejection fraction and MPI were not different. The presence of acromegaly (r = 0.29, P = 0.013), diabetes mellitus (DM) (r = 0.41, P < 0.001), hypertension (r = 0.35, P = 0.002), and sleep apnea (r = 0.56, P = 0.003) were found to be correlated with LVDD, whereas duration and activity of acromegaly were not. In regression analysis, advanced age (OR: 8.53, P = 0.006) and DM (OR: 25.9, P = 0.007) were found to be independent risk factors for LVDD. The risk of LVDD according to new criteria increases in acromegaly. However, it seems to be related to the presence of DM and advanced age and is independent of disease duration and activity.

Comparison of clinical and pathological staging in oral cavity cancers.

OBJECTIVES: This study aims to compare the clinical and pathological TN stages of patients with oral cavity cancer and to identify the factors leading to staging discrepancies. PATIENTS AND METHODS: The medical records of 125 patients (77 males, 48 females; mean age 57 years; range 19 to 82 years) who underwent primary tumor resection and neck dissection simultaneously for oral cavity cancer were retrospectively analyzed. Clinical and pathological TN stages of all patients were compared. Sensitivity, specificity and predictive values of clinical staging were calculated. RESULTS: Computed tomography (CT) with contrast which was used to examine the cervical lymph node metastasis showed a sensitivity of 71.9%, a specificity of 75%, a positive predictive value of 70.6%, and a negative predictive value of 76.1%. The diagnostic accuracy of CT for detecting mandibular invasion was as follows: sensitivity, 92.6%; specificity, 97%; positive predictive value, 96.1%; and negative predictive value, 94.3%. CONCLUSION: High correlation between clinical and pathological stages for assessment of mandibular invasion and neck metastasis supports the reliability of CT in our study. Diagnostic contribution of magnetic resonance imaging is necessary for assessment of extrinsic tongue muscle involvement; in cases of tongue cancer which are surrounded by induration on palpation and extending to the floor of the mouth.

Applying postoperative radioiodine therapy before 3 months seems to decrease ablation success in patients with differentiated thyroid carcinoma.

OBJECTIVES: Radioiodine can be applied for remnant ablation in low and low to intermediate-risk patients with differentiated thyroid cancer (DTC). A controversy still exists about the application time interval of radioiodine following total thyroidectomy. In this study, we investigated the effect of radioiodine (RAI) therapy timing on the success rates of the ablation. METHODS: We retrospectively reviewed the data of DTC patients who underwent total thyroidectomy and were treated with radioiodine remnant ablation during 2013-2017. Because the objective of this study was to determine the success of ablation according to the postoperative RAI therapy timing, any patients with a pathologic uptake outside the thyroid bed as well as high-risk patients determined before and at RAI therapy were excluded from the study. Finally, 503 patients with low and low to intermediate-risk groups were included in the study. Successful ablation was defined as no visible focal uptake on the neck on I-131 whole body scan with stimulated thyroglobulin (Tg) level of < 1 ng/mL and a normal or undetectable antithyroglobulin antibody (ATG). The time interval from total thyroidectomy to RAI therapy (titRAI) was calculated as months for each patient. RESULTS: A total of 115 (22.9%) patients were in the low to intermediate-risk group whereas most of the patients were at the low-risk group according to the American Thyroid Association (ATA) 2015. Successful ablation was observed in 388 (77.1%) patients. The titRAI was ≤ 3 months in 151 (30.0%) patients and > 3 months in 352 (70.0%) patients. The ratio of successful ablation was statistically higher in patients with a titRAI > 3 months (81.2% of patients) than in patients with ≤ 3 months (67.5% of patients) (χ2 11.247, p 0.001). The rate of successful ablation was 20.3% higher in patients treated after 3 months. There was no statistical difference when titRAI cut off was reduced to 2 months (p > 0.5). CONCLUSION: Investigated the effect of radioiodine therapy initiated before 3 months after total thyroidectomy and it seems to decrease ablation success.

Evaluation of Lateral Temporal Bone Resection in Locally Advanced Tumours of the Parotid Gland.

This study evaluated the effects of lateral temporal bone resection (LTBR) on local tumour control in patients with locally advanced parotid gland tumours. The medical records of seven patients treated with radical parotidectomy combined with LTBR for locally advanced primary parotid tumour at the Otolaryngology Department of Dokuz Eylul University between January 1995 and December 2016 were retrospectively evaluated. Demographic variables, tumour characteristics, treatment properties, postoperative complications, follow-up durations and local, regional and distant recurrences were analysed. Before referral to our clinic, four patients had de novo primary parotid tumours, and three patients had a recurrence of primary parotid tumours. The histopathologic diagnoses were squamous cell carcinoma in two patients, and adenosquamous carcinoma, malignant myoepithelial carcinoma, adenocarcinoma, adenoid cystic carcinoma and spindle cell sarcoma in the other patients. During the follow-up period, one patient died due to postoperative pulmonary embolism in the first month, and four patients died due to distant metastasis without local or regional recurrences. LTBR combined with radical parotidectomy in locally advanced primary malignant parotid gland tumours is a feasible surgical technique for local tumour control. However, the most common cause of death in these cases is distant metastases, despite appropriate resection.

Deaf adolescents have bigger responses for somatosensory and visual stimulations.

The functions of the sensory systems on disabled people have been one of the most investigated topics in brain research. In these studies, mostly visual stimuli had been employed while investigating the deaf participants. Limited number of electrophysiological studies revealed better visual sensory processing in deaf participants. On the other hand, studies deploying tactile stimuli especially used either electrical or painful stimulus or they focused the psychophysical assessments of thresholds associated with tactile stimuli. The present study tried to evaluate electrophysiological brain responses in deaf and control group with a unimodal study design including both the visual and non-painful tactile stimuli, and to reveal the possible changes in brain plasticity within modality basis. Thirteen congenitally deaf adolescents (mean: 14.61 ±â€¯1.06 years; 7 girls) and 10 adolescents with normal hearing (16.6 ±â€¯2.72 years; 4 girls) were recruited for the study. Somatosensory evoked potentials (SEP) and visual evoked potentials (VEP) were separately delivered to the participants and in order to maintain neutrality among sessions they were presented in random order while the electroencephalography (EEG) recordings were taken. Brain responses to non-painful tactile and visual stimuli were measured for N1, P2, and N2 components. All amplitudes of deaf group were significantly larger than all amplitudes of control group in SEP session whereas in VEP session only P2 and N2 amplitudes of deaf group were statistically larger. In addition, the latency of N1 component in VEP session was significantly earlier in deaf group. These findings suggest early cortical excitability, less neuronal capacity usage and also more efficient sensory processing in deaf group.

Effect of deep breathing exercises on oxygenation after major head and neck surgery.

OBJECTIVES: To investigate respiratory and hemodynamic responses to deep breathing exercise (DBE) during the follow-up period in the intensive care unit after major head and neck surgery. STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: Thirty-five patients were instructed to perform DBE every hour for 3 consecutive hours during the first postoperative day. The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO(2)/FiO(2)), oxygen saturation (SpO(2)), respiratory rate (RR), heart rate (HR), and mean arterial pressure (MAP) was recorded. RESULTS: DBE increased the PaO(2)/FiO(2) ratio from 416.7 +/- 143.6 to 453.4 +/- 141.4 mm Hg and increased SpO(2) from 97.4 +/- 1.9 to 99.2 +/- 0.9. DBE decreased the RR from 24.1 +/- 3.3 to 21.8 +/- 2.9 breaths/min (P < 0.05). No statistically significant difference in HR or MAP was observed after DBE (P > 0.05). CONCLUSION: DBE improves oxygenation after major head and neck surgery, without causing additional harmful hemodynamic effects.

Sound energy absorbance characteristics of cartilage grafts used in type 1 tympanoplasty.

OBJECTIVE: The purpose of this prospective case-control study is to evaluate the sound energy absorbance characteristics of cartilage grafts in patients, who have undergone type 1 cartilage tympanoplasty. METHODS: Thirty-four operated ears of 32 patients and 70 ears of 35 control subjects were included. Differences of pure-tone audiometry thresholds and wideband ambient-pressure absorbance ratios with respect to the graft material, graft thickness, cartilage surface area ratio and elapsed time after surgery were analyzed. Receiver operating characteristics curve was generated to detect the absorbance level at which the reconstructed tympanic membrane behaves as 'near-normal tympanic membrane'. RESULTS: In the surgical group, wideband energy absorbance ratios at all 1/2-octave band frequencies were significantly worse than normal ears. Energy absorbance ratios at 2000 and 2828Hz frequencies were higher in patients with tragal cartilage grafts. Higher absorbance ratios at 250-750Hz range were obtained in patients with 400µm cartilage graft thickness, <50% cartilage surface area ratio and ≥5 years since surgery. A multivariate generalized linear model revealed common effects of the independent variables at 8000Hz. The receiver operating characteristics analysis generated a cut-off level of 63.20% of sound energy absorbance at 1400Hz with 83% sensitivity and 88% specificity. CONCLUSION: Even though no differences in hearing thresholds were observed; graft material, graft thickness, cartilage surface area ratio and elapsed time after surgery affected the course of sound energy absorbance after type 1 cartilage tympanoplasty as evidenced by wideband tympanometry.

Airway and sleep disorders in patients with acromegaly.

OBJECTIVE: Acromegaly is a multisystemic disorder caused by excessive secretion of growth hormone (GH). Sleep-disordered breathing (SDB) such as sleep apnea syndrome (SAS) may occur in acromegaly. The aim of study was to assess the presence of sleep disorders and evaluate the systemic complications on respiratory, cardiovascular, and upper airway systems in acromegalic patients. METHODS: The study group consisted of 30 acromegaly outpatients. GH and insulin-like growth factor 1 (IGF-1) measurements were obtained; body pletysmography, arterial blood gas analysis, tissue-doppler imaging, echocardiography, polysomnography, otorhinolaryngologic examination, and head-neck computed tomography were performed. RESULTS: Sixteen female (53.3%) and 14 male (46.7%) acromegalic patients had a mean age of 51.1 ± 13.2. GH was supressed in 19 patients (63.3%) when 11 had active acromegaly (36.7%). There were 17 patients with SAS (62.9%) (7: mild, 3:intermediate, 7:severe SAS) and average AHI was 16/h. Sixteen patients had predominantly obstructive SAS while one patient had predominantly central SAS. SAS was statistically more frequent in males than females (P = .015). The mean neck circumference was significantly longer in patients with SAS (P = .048). In SAS patients,the soft palate was elongated and thickened,which was statistically significant (P = .014 and P = .05).Vallecula-to-tongue distance was statistically longer in acromegalic patients with SAS (P = .007).There was a positive correlation between tonsil size,vallecula-to-tongue distance and AHI (r = 0.432, P = .045 and r = 0.512, P = .021, respectively). CONCLUSION: SDB seems to be common and clinically important in patients with acromegaly, particularly in men. The most frequent type of apnea in acromegalics is obstructive. Hormonal activity of acromegaly does not seem to have an effect on the development of SAS. Despite its high prevalence, SAS is frequently under-assessed in patients with acromegaly. Systemic complications and SDB should be researched in acromegalics.

Hearing loss and middle ear involvement in patients with juvenile idiopathic arthritis.

OBJECTIVE: Evaluation of the hearing status and middle ear function of patients with juvenile idiopathic arthritis. METHODS: The study group was comprised of 38 ears of 19 patients (6 males, 13 females) aged between 5 and 23 years. The control group was comprised of 30 ears of 15 healthy subjects (5 males, 10 females) aged between 5 and 22 years. All subjects were examined audiologically using tympanometry, stapedial reflex, acoustic reflex decay, pure-tone audiometry, high frequency audiometry and transient evoked otoacoustic emission tests. RESULTS: There were statistically significant (p<0.05) number of ears (32%) with abnormal tympanograms in the patient population while all tympanograms were normal, type A in the control group. Seven type As, 2 type Ad, and 3 type C tympanograms were seen in the patient population. In pure tone audiometry tests there was no subject having neither a conductive nor sensorineural hearing loss individually in both groups. But as a group, patients with juvenile idiopathic arthritis showed statistically significant elevation of air conduction thresholds at frequencies of 250, 500, 6000, 14,000 and 16,000 Hz for right ears; and at 500, 2000, 12,500 and 16,000 Hz for left ears; and larger air-bone gaps at 500 and 2000 Hz for right ears; and at 500 Hz for left ears (p<0.05). Comparison of bone conduction thresholds and otoacoustic emission tests between both groups did not reveal any statistically significant difference (p>0.05). CONCLUSION: This study suggests a dual effect of disease on both the middle and inner ear of patients with juvenile idiopathic arthritis. Presence of abnormal tympanograms together with worse air conduction thresholds at lower frequencies as well as larger air bone gaps at frequencies of 500 and 2000 Hz suggest subclinical middle ear involvement; while hearing losses at 6000 Hz and very high frequencies of 12,500, 14,000 and 16,000 Hz suggest inner involvement at an early stage.

CT and virtual endoscopy findings in congenital laryngeal web.

Laryngeal web is a rare lesion resulting from incomplete recanalization of the primitive larynx. Because the extent of airway involvement affects surgical management, patients should be studied thoroughly before treatment. Although the diagnosis is based on the endoscopy findings in most of the cases, laryngoscopy may fail to show the subglottic extension of the disease. Virtual endoscopy may provide the information needed for surgery in such cases. Here, we report the computed tomography and virtual endoscopy findings in a 5-year-old child with a laryngeal web.

Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking.

OBJECTIVE: In this retrospective cohort study, we aimed to determine the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) and to define the possible predictors for PCF formation. METHODS: The medical records of 198 patients with laryngeal squamous cell carcinoma who underwent TL were reviewed. After the exclusion of patients with history of free flap reconstruction, previous laryngeal surgery, and previous radiotherapy (RT) for other primary cancers, the risk factors for PCF were analyzed in 183 patients who were included in the study. RESULTS: The overall incidence of PCF was 20.2%. A history of heavy smoking and previous RT were detected as independent risk factors in both univariate (p=0.004 and p=0.007, respectively) and multivariate (p=0.005) analyses. Preoperative tracheotomy (PT) longer than 14 days was a risk factor for PCF among patients with PT in the univariate analysis (p=0.031). Overall three- and five-year survival rates were statistically indifferent between the PCF and non-PCF groups (p>0.05). However, the overall five-year survival rate was lesser in the persistent PCF group (47%) than in the non-persistent PCF group (83%) (p=0.038). CONCLUSION: Heavy smoking and previous RT are independent risk factors for PCF, and the persistence of PCF decreases survival rates. Preventable measures should be taken to decrease the incidence and persistence of this complication of TL in the management of patients with possible risk factors.