Change in Warthin's tumor incidence: a 20-year joinpoint trend analysis.

PURPOSE: The incidence of Warthin's tumor (WT) has increased worldwide. In this study, we aimed to evaluate the incidence of WT in our hospital, which provides health care for an extremely large population. METHODS: We retrospectively evaluated 573 patients, comprising 345 males and 228 females, who all experienced parotid tumor for the past 20 years. Patients with WT that were operated in the last 20 years were evaluated according to the number of patients per year to determine the annual WT increase trend. RESULTS: In the distribution of WT over the years of surgery, the ratio of WT to all tumors irregularly changed. Furthermore, the total number of parotidectomies per year increased in time. We investigated whether WT had any increasing trend over the years. The annual percentage change (APC) of WT was calculated, and according to the segmented regression analysis, the APC was insignificant (APC = 4.3, 95% CI = - 3.6-12.9, P = 0.300). CONCLUSION: The incidence of WT has increased across the world. However, in our study, no significant APC was observed according to the segmented regression analysis.

Cervical Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis.

In this study the authors evaluated the outcomes of tracheal resection and anastomosis in postintubation tracheal stenosis. The authors also aimed to identify clinical and radiological factors associated with restenosis. Thirty-four consecutive patients were included in the study. Patients with subglottic stenosis who underwent procedures involving cricoid cartilage and patients with other etiologies were excluded from the study. Univariate analysis was performed to determine the risk factors for restenosis. Receiver operating characteristic (ROC) curves were generated for the diameter of the narrowest part of the trachea (Dst) and the distance between cricoid cartilage and stenosis (Dcs). Of the 34 patients, 31 (91.1%) patients were successfully decannulated. Nineteen (55.8%) patients had complications. After univariate analysis, Dst (P = 0.001), Dcs (P = 0.001), smoking (P = 0.007) and grade of the stenosis (P = 0.003) were significantly associated with restenosis. The sensitivity and specificity were 90.9% and 77.3%, respectively, when the cutoff value for Dst was 4 mm. Sensitivity and specificity were 72.7% and 100%, respectively, when the cutoff value for Dcs was 10 mm. Tracheal resection and anastomosis is an effective surgical method for treating postintubation tracheal stenosis. In our series, 91.1% of the patients with postintubation tracheal stenosis were successfully decannulated. Restenosis was the most common complication. The diameter of the narrowest part of the trachea (Dst), the distance between cricoid cartilage and stenosis (Dcs), smoking and grade of stenosis were significantly associated with restenosis.

Outcomes of cochlear implantation in children with and without inner ear malformations.

OBJECTIVE: To evaluate the auditory functions and progress of speech development in children with and without cochlear anomalies who underwent cochlear implantation due to prelingual profound sensorineural hearing loss (SNHL). METHODS: This study was conducted at Gaziantep University Faculty of Medicine Ear-Nose-Throat Department, between October 2006 and December 2007. A total of 69 children (aged 6 to 24 months) diagnosed with profound SNHL were included. Patients were divided into two groups with respect to the presence of inner ear anomalies: Group-1 consisted of 41 children without inner ear anomaly, whereas Group-2 was composed of 28 patients with inner ear anomalies. The auditory performance was assessed using Listening Progress Profile Test (LPPT) and Monosyllabic Trochee Polysyllabic Test (MTP), the subsections of Evaluation of Auditory Responses to Speech (EARS) test battery. RESULTS: Preoperative LPPT scores were 5 (12%) in both groups. Mean LPPT values after fitting in Group-1 and Group-2 on 1st, 3rd and 6th months were 18.5 (44.1%) and 19 (45.6%); 27 (64.2%) and 28 (67.3%); 31 (75%) and 34 (83%), respectively. Postoperatively, MTP scores in Group-1 and Group-2 were 7.5 (62%) and 7.7 (64%) for 3-words set; 10.4 (58%) and 10.6 (59%) for 6-words set; 14.3 (60%) and 14 (59%) for 12-words set, respectively. The rate of stimulation for electrodes was 1345 q/u (quick/unit) in Group-1 and 1310 q/u in Group-2. No statistically significant difference was detected between groups for variables under investigation. CONCLUSION: Cochlear implantation is an effective treatment in children with prelingual profound SNHL. Auditory performance and advancement of speech are similar for children with and without inner ear anomalies.

Treatment of Congenital Choanal Atresia via Transnasal Endoscopic Method.

OBJECTIVES: Congenital choanal atresia (CCA) is a very rare abnormality of the nose, but in the case of bilateral presence, it becomes a life-threatening malformation. Various surgical treatment options, such as transpalatal, transseptal, and open rhinoplasty techniques, as well as the transnasal approach, have been defined for the repair of CCA. In this study, the authors intended to evaluate the outcomes of transnasal endoscopic surgery for CCA, and stent implementation's impact on surgical success. METHODS: Patients who were admitted to the Otorhinolaryngology Department of Gaziantep University and patients who had not undergone CCA surgery before were included in the study. Patients who underwent transnasal endoscopic choanal atresia surgery (TECAS) were advised to have regular nasal endoscopic examinations performed at check-ups; after a 6-month follow-up period, surgical results were evaluated concerning whether stenosis had occurred or not. RESULTS: Of the 48 patients who underwent TECAS after a minimum 6-month follow-up period, 34 of patients revealed no stenosis, so the overall surgical success rate was 70.8%. Fourteen (29.2%) patients who underwent TECAS developed stenosis and required revision surgery. CONCLUSIONS: Transnasal endoscopic choanal atresia surgery is the most preferred approach for CCA repair and has many advantages, such as excellent vision, shorter operative time, minimal bleeding, and minimum complication. Despite advances in endovision systems and surgical instruments, stenosis is the most challenging problem after TECAS, so new treatment strategies should be developed to prevent stenosis.

Masking Treatment and its Effect on Tinnitus Parameters.

OBJECTIVE: Tinnitus is described as the perception of sound without any external acoustic stimulation. Any pathology of auditory pathways or any system of the human body may result with tinnitus. The pathophysiology of tinnitus accompanying the disorders of auditory system is not fully understood and there is not any particular effective treatment method has been specified. Tinnitus masking therapy has been reported as an effective treatment modality in the treatment of tinnitus. In this study, the results of tinnitus masking treatment on the parameters were evaluated prospectively. PATIENTS AND METHODS: Patients with normal physical examination was enrolled in the study. Blood tests (complete blood count, biochemical analysis of lipid profile, and thyroid hormones), pure tone audiometry, tympanometric measurement of the middle ear pressure and stapedial reflexes were performed, Sixty six patients with normal results of blood tests and normal hearing thresholds with type A tympanogram were included. Tinnitus sufferers questionnaires (socio-demographics, clinical information, Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI) was filled, audiological tests were performed, tinnitus parameters (frequency, intensity, minimal masking levels, residual inhibition) were measured. After four weeks of the treatment the questionnaires were repeated. RESULTS: Masking treatment for tinnitus patients resulted with significant decrease in Tinnitus Handicap Inventory and VAS scores. After four weeks of the masking treatment the questionnaire was repeated. Twenty patients did not respond to treatment. CONCLUSION: Masking therapy is one of the most effective methods of treatment for tinnitus patients. Masking therapy, that is not invasive and cost-effective has an important place in the treatment of tinnitus. Especially in a short time provides a significant reduction in tinnitus parameters.

Predictive factors for malignancy in patients with persistent cervical lymphadenopathy.

The aim of this study was to identify clinical factors that can predict malignancy in patients with persistent cervical lymphadenopathy. This retrospective study included 575 patients with persistent cervical lymphadenopathy who underwent surgical excision. The patients were divided into two groups according to their ages: group 1 (≤18 years) and group 2 (>18 years). Multiple logistic regression models and univariate analysis were performed to determine the association between clinical factors and malignancy. Male gender [odds ratio (OR) 4.184, 95 % confidence interval (CI) 1.823-9.602, p = 0.001], increased age (OR 1.072, 95 % CI 1.001-1.148, p = 0.046), left-sided lesions (OR 3.423, 95 % CI 1.407-8.329, p = 0.007), and larger lymph node size (OR 1.445, 95 % CI 1.021-2.044, p = 0.038) were significantly associated with malignancy in group 1. Male gender (OR 3.761, 95 % CI 2.361-5.992, p = 0.001), increased age (OR 1.015, 95 % CI 1.003-1.027, p = 0.018), duration of the disease (OR 0.770, 95 % CI 0.668-0.888, p = 0.001), and the presence of B symptoms (OR 4.996, 95 % CI 2.862-8.721, p = 0.001) were significantly associated with malignancy in group 2. The sensitivity and specificity of the models were 84 and 61.5 % for group 1 and 77.9 and 67.9 % for group 2, respectively. Increasing age and male gender were found to be associated with malignancy in all age groups. Larger lymph node size and left-sided lymphadenopathy were significant predictors of malignancy in children. Presence of B symptoms was found to be associated with malignancy in adults. Our results indicated that increasing duration of lymphadenopathy and the presence of bilaterality render the lymph node more likely to be benign in adults. No significant association was found between the involved neck site and malignancy for all age groups.

Effectiveness and Safety of Selective Neck Dissection in Lymph Node-Positive Squamous Cell Carcinoma of the Head and Neck.

The aim of this study was to investigate the effectiveness and safety of selective neck dissection in patients with lymph node-positive head and neck squamous cell carcinoma to determine regional control and survival rates. Eighty patients with lymph node-positive head and neck squamous cell carcinoma who underwent selective dissection were included in the study. Regional control, survival rates, and factors affecting survival were analyzed. Regional control was 90%, disease-specific survival was 93.4%, and the overall survival rate was 87.25%. T stage, N stage, age, and extracapsular spread were included in hazard regression models. None of the factors were statistically significant. Selective neck dissection is an effective and oncologically safe treatment option in selected cases. T stage, N stage, and extracapsular spread had no significant impact on disease-specific survival.

Management of upper aerodigestive tract amyloidosis.

OBJECTIVES: The aim of this study was to discuss the treatment options for upper aerodigestive tract amyloidosis. METHODS: Four patients with histologically confirmed amyloidosis were included in the study. All patients underwent surgical treatment. Three patients had laryngeal amyloidosis, and 1 patient had tonsillar amyloidosis. RESULTS: Two of the cases of laryngeal amyloidosis were successfully treated with a combination of surgery and radiation therapy. One case of laryngeal amyloidosis was treated with surgery alone. The tonsillar amyloidosis was removed by tonsillectomy. None of the cases showed systemic involvement. Long-term follow-up of the patients showed no recurrence or evidence of systemic disease. CONCLUSIONS: Surgical resection is the primary treatment for patients with upper aerodigestive tract amyloidosis. Radiation therapy is especially effective in cases of recurrent amyloidosis with submucosal involvement. Pedunculated polypoid lesions may be treated with surgery alone, and in cases of recurrence, irradiation following the surgical removal should be considered. Tonsillectomy is usually sufficient for treating tonsillar amyloidosis.

Oxidative stress in chronic otitis media.

Chronic otitis media usually presents with a benign tumor-like lesion of the temporal bone known as a cholesteatoma. The role of oxidative stress in the pathogenesis of chronic otitis media and cholesteatoma has not yet been fully explored. Therefore, the aim of this study was to investigate the oxidative stress markers and antioxidant enzymes in patients with cholesteatomatous and noncholesteatomatous chronic otitis media and in healthy subjects. A prospective controlled trial was performed on cholesteatomatous and noncholesteatomatous chronic otitis media patients in a tertiary referral center in a university hospital. A total of 75 subjects, including 25 cholesteatomatous and 25 noncholesteatomatous chronic otitis media patients and 25 healthy subjects participated in this study. Serum total oxidant status (TOS) and oxidative stress index (OSI) levels were significantly increased in the patient groups with or without cholesteatoma compared with the control group. Serum total antioxidant status (TAS) levels and Paraoxonase and arylesterase activity were significantly lower in the patient groups with or without cholesteatoma compared with the control group. Serum TOS and OSI levels were lower in the noncholesteatomatous group, whereas serum TAS levels were higher compared with the cholesteatomatous group. Serum arylesterase activity was significantly lower in the noncholesteatomatous group compared with the control group. The results of this study reveal that in cholesteatoma cases, the oxidative stress and antioxidant enzyme imbalance were more significant than in cases of chronic otitis media without cholesteatoma.

Systemic steroid versus combined systemic and intratympanic steroid treatment for sudden sensorineural hearing loss.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of oral steroid treatment versus combined oral and intratympanic dexamethasone injection for idiopathic sudden sensorineural hearing loss. METHODS: This was a retrospective case review in which 30 patients in the oral steroid group and 39 patients in the combined oral and intratympanic steroid injection group were compared. RESULTS: The comparison of the initial pure tone audiometry (PTA) threshold results revealed a significant difference between the systemic steroid (SS) group and the systemic and intratympanic steroid group. The initial PTA was 74.33 ± 22.64 dB (mean ± SD) in the SS group and 87.49 ± 26.22 dB (mean ± SD) in the intratympanic steroid group. The difference in the initial PTA results was statistically significant between the SS group and intratympanic steroid group (P < 0.05, P = 0.032). The pure-tone gain in the SS group was 20.97 ± 27.47 dB (mean ± SD), and that of the group treated with both systemic and intratympanic steroids was 19.36 ± 22.16 dB (mean ± SD) (P = 0.49). CONCLUSIONS: The results of this study indicate that, in sudden sensorineural hearing loss, the administration of intratympanic steroids in conjunction with SS therapy appears to have the same effect on the restoration of hearing "as the effect obtained using SS therapy alone."

Complications and treatment of chronic otitis media.

OBJECTIVE: The aim of this study was to investigate the etiologic factors and treatment types for chronic otitis media (COM) complications. METHODS: In this study, the data from 82 patients who had been diagnosed and treated at the Departments of Otolaryngology and Neurosurgery of Gaziantep University between 1999 and 2011 for complications from COM were retrospectively reviewed. The chosen surgical procedure was based on the type of complication and the ear pathology. RESULTS: The study included 55 male and 27 female patients. Ten patients (12.2%) had intracranial complications, and 72 patients (87.80%) had extracranial complications. There were 47 patients with cholesteatoma. Radical mastoidectomy was performed on 46 patients, canal-wall-down mastoidectomy was performed on 30 patients, and canal-wall-up mastoidectomy was performed on 6 patients. Five patients underwent neurosurgical operations because of COM complications. CONCLUSIONS: Although the rate of COM complications has recently declined, it remains important to diagnose COM without delay and to use appropriate treatments for the patients because COM complications are associated with poor outcomes.

Late metastasis of an intracranial meningioma to the hard palate.

Meningiomas are benign neoplasms that arise from cellular elements of the meninges. Although meningiomas are usually considered as benign tumors, they have a potential to become aggressive and to metastasize to the extracranial structures. Distant metastasis most commonly occurs in lung, liver, and long bones. We present an extremely rare case of a delayed metastasis of a recurrent intracranial meningioma to the hard palate 19 years after the initial diagnosis. The patient underwent surgical excision without any complication and follow-up showed no recurrence.

Paranasal sinus osteomas.

Osteoma is the most common benign tumor of the paranasal sinuses. They remain asymptomatic until the tumor reaches a certain size. Although the etiology of the osteomas is controversial, embryologic, traumatic, and infective theories have been proposed. Osteomas may be discovered at any age but are usually found during the fourth and fifth decades, and there is a male preponderance. In this retrospective study, we analyzed 25 patients with paranasal sinus osteomas who were treated surgically between 2005 and 2011. Age and sex of the patient, size and location of the tumor, clinical presentation, type of surgical approach, duration of follow-up, outcome, and any intraoperative or postoperative complications were obtained from the medical records of the patients. Diagnosis of osteoma was based on computed tomography findings and confirmed histopathologically in all cases. There were 9 men (36%) and 16 women (64%) with a mean age of 38.7 years. Tumor localization was divided as follows: ethmoid sinus in 14 patients (56%), frontal sinus in 9 patients (36%), and maxillary sinus in 2 patients (8%). Mean tumor size was 2.04 cm, ranging from 0.5 to 6.5 cm. External approach was used in 9 cases and endonasal endoscopic surgery was performed in 19 cases. Combination of endoscopic surgery and external surgery was performed in 3 cases. After at least 6 months of follow-up, all patients were symptom-free except 2 patients who underwent revision surgery. These 2 patients were also asymptomatic following revision surgery. Although there is an increasing trend to endoscopic surgery, external approach is recommended in large frontal osteomas and ethmoid osteomas with lateral extension and in case of intracranial or intraorbital involvement.

Intraorbital isolated mucocele.

A 55-year-old man was presented with an orbital mass. The magnetic resonance imaging revealed that the dimensions of the mass were 29×19×17 mm. The most probable diagnosis with the magnetic resonance imaging findings was dermoid cyst. The mass was a cyst and marsupialized by functional endonasal endoscopic sinus surgery without any complication. Intraoperative findings of the mass were thought to be a hydatid cyst, but the diagnostic tests were negative, and the pathologic result was consistent with mucocele.

Electrophysiologic assessment of the subclinical changes in facial functions after parotidectomy.

OBJECTIVE: Our objective was to evaluate whether there was a subclinical change in the functions of the facial nerve after parotidectomy. METHODS: Facial nerve functions of 21 patients who had parotidectomy between January 1999 and December 2003 were assessed using electromyography (EMG) at least 5 years after the surgery. RESULTS: There was no significant difference between both sides of the face in the EMG amplitudes (P > 0.05) except for the amplitudes obtained from the site of nasolabial sulcus (P < 0.05). In the patients who underwent total parotidectomy, the EMG amplitudes were significantly different for both sides of the face (P < 0.05). No significant difference was found in the comparison of other measurements performed by EMG. CONCLUSIONS: Tumor histopathologic type (benign or malignant) and type of parotidectomy (superficial or total) do not cause a subclinical dysfunction of the facial nerve after parotidectomy in the patients who also have clinically normal facial functions. The only exception to this contention is the subclinical dysfunction in nasal branches of the facial nerve in total parotidectomy cases.

Giant ethmoidal mucocele leading to proptosis and hypertelorism in a pediatric patient with cystic fibrosis: a case report.

BACKGROUND: Chronic sinusitis and its complications are common in patients with cystic fibrosis. Mucoceles are one of these complications and can have life-threatening consequences if left untreated. CASE: We present the case of a giant ethmoid mucocele leading to proptosis and hypertelorism in a 5-year-old child with cystic fibrosis. CONCLUSION: Chronic sinusitis and its complications are common in patients with CF. Mucoceles are a rare complication of sinusitis that can be treated surgically. As seen in this case if left untreated mucoceles can lead to orbital pathologies such as proptosis, hypertelorism. To the best of our knowledge, we report the first case report of giant ethmoidal mucocele leading to proptosis and hypertelorism in a patient with cystic fibrosis.

Incudostapedial rebridging ossiculoplasty with bone cement.

OBJECTIVE: The purpose of this study is to evaluate hearing results of our experience with ionomeric bone cement repair of ossicular discontinuity between incus and stapes. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: One hundred thirty-six patients who underwent incudostapedial rebridging ossiculoplasty with ionomeric bone cement were included in the study. Preoperative and postoperative audiologic results of incudostapedial rebridging ossiculoplasty with bone cement were evaluated. One year of follow-up is provided. RESULTS: The postoperative air-bone gap was less than 20 dB in 81.6 percent after one year. The mean preoperative and postoperative pure-tone avarages of the patients were 52.82+/-5.59 and 32.81+/-7.18 dB, respectively (P<0.01). The mean preoperative and postoperative air-bone gaps were 35.83+/-4.73 and 16.54+/-5.01, respectively (P<0.01). There were no statistically significant differences among the hearing results of different types of surgeries (P>0.05). No complications in the middle ear related to bone cements were encountered. CONCLUSIONS: Incudostapedial rebridging ossiculoplasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.

Surgical treatment of inverted papilloma.

Inverted papilloma (IP) is the most common benign tumor of the nose and the paranasal sinuses and constitutes almost 0.5% to 4% of the primary nasal tumors. In this study, our objective was to retrospectively review the results of surgical treatment of IP.Sixty-eight patients with a histopathologically proven diagnosis of IP were retrospectively evaluated. Two patients who had an associated squamous cell carcinoma were excluded from the study. Ten patients were operated on for revision surgery, and 56 eventually had a primary tumor. Patients operated on for primary tumor were included in this study. Nasal obstruction was the most frequent symptom observed in 50 patients (89%). The origin of the tumor was most common at the maxillary sinus, the lamina papyracea, and the ethmoid sinus. Endoscopic endonasal resection, endoscopic endonasal resection with the Caldwell-Luc procedure, medial maxillectomy after lateral rhinotomy (LR), and endoscope-assisted medial maxillectomy with LR approaches were used. The patients operated on only with medial maxillectomy after an LR procedure have a recurrence rate of 28% (2 patients). Endoscopic endonasal resection has a recurrence rate of 9% (2 patients). Recurrence observed after endoscopic endonasal resection with Caldwell-Luc procedures was 7% (1 patient). One recurrence (8%) was determined after an endoscope-assisted medial maxillectomy after LR. No major postoperative complications were observed after surgery.In conclusion, IP can be treated both with internal and external approaches. The type of surgery should be determined according to the tumor stage. Combined internal and external approaches have less recurrence rates in advanced cases. Endoscopic endonasal resection should be used in early-stage tumors.

Primary hydatid cyst of the infratemporal fossa.

Hydatid cyst disease is a rare parasitic disease caused by the larval stage of Echinococcus. This parasite in the larval stage can thrive in many parts of the body, most frequently in the liver. Head and neck involvement of the disease is rare. Herein, we present a case of primary hydatid cyst occurring in the infratemporal fossa, which is an extremely rare localization.

Alveolar soft part sarcoma of the tongue.

Alveolar soft part sarcoma is a rare type of sarcoma that usually affects young adult women. It occurs mostly in the lower extremities, and nearly one quarter of the cases are found in the head and neck region. The most common site of origin in the head and neck region is the tongue followed by the orbit. Herein, we present an unusual case of alveolar soft part sarcoma of the tongue in an 18-year-old woman. The clinical, diagnostic, and therapeutic features of this quite rare entity were discussed.