A rare cause requiring consideration in the differential diagnosis of neck masses: tularemia.

INTRODUCTION: Tularemia is a zoonotic disease caused by the Gram-negative coccobacillus Francisella tularensis. It is frequently overlooked in the differential diagnosis of neck masses because of its rarity. The purpose of this study is to report cases diagnosed with tularemia among patients presenting to our clinic with neck masses and to share our experience. METHODOLOGY: Patients presented to our hospital with cervical masses and diagnosed with tularemia were included in this retrospective study. Medical files of all patients were evaluated, and physical examination findings, titration values, date of diagnosis, location of the abscess or mass, place of residence, occupation, drinking water sources, sedimentation (SED), C-reactive protein (CRP), and white blood cell (WBC) values were recorded. RESULTS: Seventy-six patients were included in the study. Forty patients (52.6%) were living in rural villages and 36 (47.4%) in urban areas. Thirty-one (40.8%) were engaged in animal husbandry and 29 (38.2%) in agriculture. In terms of drinking water sources, 59 patients (73.6%) obtained water from the mains, while 10 (13.32%) used well water. The most frequently observed clinical findings were swelling in the neck, sore throat, lethargy, and fever. Neck swelling frequently occurred in levels II and III. CONCLUSIONS: Since tularemia is rare and there are no specific clinical findings, diagnosis may be problematic. Ear, nose and throat (ENT) specialists should be familiar with the clinical symptoms of tularemia in the head and neck region and should consider a preliminary diagnosis of tularemia in the differential diagnosis of persistent neck masses.

Unexpected Tumor in an Elderly Patient: Nasopharyngeal Angiofibroma.

Although nasopharyngeal angiofibroma is an expected tumor in adolescent males, it is uncommon in the elderly. Because of its high vascularity or bleeding during biopsy, surgical resection can be life threatening. Therefore, nasal angiofibroma should be kept in mind in existing masses especially in elderly patients and support should be obtained from imaging methods.

Born in the Ear Canal: Tick Larva on the Eardrum.

We report the case of a 54-year-old woman who presented to the ear, nose, and throat (ENT) outpatient clinic with hearing loss, tinnitus, and fullness in her right ear. In the first clinical examination, a pouch hanging in the anterior upper quadrant was detected in the tympanic membrane of the right ear. A tick larva was found in the cyctic lesion located on the tympanic membrane. Our case was unique due to this unexpected diagnosis.

The protective effect of Naringenin against ovalbumin-induced allergic rhinitis in rats.

BACKGROUND: Allergic rhinitis (AR) is a ubiquitous chronic disease with a growing incidence. We aimed to investigate the protective effect of naringenin against AR induced in rats. METHODS: Thirty-two Sprague Dawley rats were divided into four groups of eight animals each. Group 1 represented the control group. The other 24 rats were sensitized with intraperitoneal 0.3 mg ovalbumin (OVA) and 30 mg aluminum hydroxide every other day for 14 days to induce AR. Ten microliters OVA was administered to both nostrils by inhalation for the following seven days to provoke AR. Group 2 represented the AR group and received no treatment. Group 3 was treated as the reference group and received 5 mg/kg desloratadine every day between days 15 and 21. Group 4 received 100 mg/kg naringenin orally between days 15 and 21. All animal's sneezing and nasal itching scores were recorded on day 22. The rats were then sacrificed. Serum total IgE, IL4 and IL5 values were studied, and nasal structures were extracted 'en bloc' for histopathological examination. RESULTS: Significant clinical recovery was achieved in the group treated with naringenin. Serum total IgE, IL4 and IL5 values in the naringenin group were significantly lower than in the AR group, and significant histopathological improvement was observed compared to the AR group. CONCLUSIONS: Naringenin produced significant clinical, biochemical and histopathological benefits in rats with induced AR. These effects suggest that naringenin is a promising agent for the treatment of AR.

Are Vitamin D Levels Associated With Risk of Deep Neck Infection?

Deep neck infection (DNI) refers to infections in spaces created by superficial and deep cervical fascia around the muscles and organs in the neck. Vitamin D is highly important for an effective immune system. Vitamin D receptors (VDR) have been identified in immune system cells, and particularly in T and B lymphocytes, macrophages, and dendritic cells. Vitamin D deficiency is thought to result in impaired immune response, decreased leukocyte chemotaxis, and an increased disposition to infection. The purpose of this study was to investigate whether vitamin D deficiency is an underlying occult factor in the development of DNI. Sixty-five patients aged 6 to 90, diagnosed with DNI, and 70 healthy age- and sex-compatible cases were included in the study. Serum levels of calcium, phosphorus, parathyroid hormone, and 25-hydroxy vitamin D (25(OH)D) were determined in each case. 25-hydroxy vitamin D levels above 20 ng/mL were regarded as normal, 12 to 20 ng/mL as insufficient, 5 to 12 ng/mL as deficient, and less than 5 ng/mL as severely deficient. Mean serum 25(OH)D levels were 10.4 (6.2) ng/mL in the patient group and 15.5 (6.4) ng/mL in the control group (P < .01). This difference was statistically significant (P < .01). Vitamin D was within normal limits in 9.2% (n = 6) of cases in the study group, insufficient in 29.2% (n = 19), deficient in 35.3% (n = 23), and severely deficient in 26.2% (n = 17). The equivalent values in the control group were 21.4% (n = 15), 48.5% (n = 34), 30% (n = 21), and 0% (n = 0). Serum 25(OH)D levels were significantly lower in patients with DNI compared to the healthy cases; 25(OH)D levels may be a factor in the development of DNI.

Preoperative Serum Thyroglobulin Level as a Useful Predictive Marker to Differentiate Thyroid Cancer.

INTRODUCTION: Thyroid cancer is the most common endocrine system cancer. Although fine-needle aspiration biopsy is the most commonly used method for diagnosis, it is not always sufficient. The aim of this study was to investigate the influence of preoperative serum thyroglobulin (Tg) concentration on differentiated thyroid cancer risk. MATERIAL AND METHODS: A total of 133 patients who underwent total thyroidectomy due to various indications at the Ear-Nose-Throat Department, Ataturk University Medical School, between April 2015 and December 2015, were included in this prospective study. Histopathological diagnosis and preoperative Tg levels were compared. Receiver operating characteristic (ROC) analysis was used for detection of the cut-off to discriminate malignant from benign thyroid masses using preoperative Tg as a variable. RESULTS: Malignant pathology (differentiated thyroid carcinoma) was detected in 59 out of 133 patients (44.4%) and benign pathology in 74 (55.6%). A statistically significant difference in preoperative Tg value was detected between malignant and benign cases (p < 0.05). CONCLUSION: The prevalence of differentiated thyroid carcinoma was higher among patients with a preoperative serum Tg value > 188.5 ng/mL, and this may thus be used as a marker for the diagnosis of this malignancy.

Post-operative pain control after tonsillectomy: dexametasone vs tramadol.

CONCLUSION: Tramadol was found to be more effective than dexamethasone in post-operative pain control, with long-lasting relief of pain. OBJECTIVE: This study aimed to compare the effects of pre-operative local injections of tramadol and dexamethasone on post-operative pain, nausea and vomiting in patients who underwent tonsillectomy. DESIGN: Sixty patients between 3-13 years of age who were planned for tonsillectomy were included in the study. Patients were divided into three groups. Group 1 was the control group. Patients in Group 2 received 0.3 mg/kg Dexamethasone and Group 3 received 0.1 mg/kg Tramadol injection to the peritonsillary space just before the operation. Patients were evaluated for nausea, vomiting, and pain. RESULTS: When the control and the dexamethasone groups were compared; there were statistically significant differences in pain scores at post-operative 15 and 30 min, whereas there was no statistically significant difference in pain scores at other hours. When the control and tramadol groups were compared, there was a statistically significant difference in pain scores at all intervals. When tramadol and dexamethasone groups were compared, there was no statistically significant difference in pain scores at post-operative 15 and 30 min, 1 and 2 h, whereas there was a statistically significant difference in pain scores at post-operative 6 and 24 h.

Excellent Result With the Use of Single-Dose OK-432 in Cervical Macrocystic Lymphangioma.

Though the lymphangioma is a benign neoplasm, it may make an invasion to vital structures by progressively growing. For lymphangioma, which progressed in such a way, surgical treatment has high morbidity and recurrence risk. On these cases, OK-432 is a frequently used sclerotherapy agent. The authors report the result they obtained by the use of single-dose OK-432 on an inoperable pediatric cervical macrocystic lymphangioma case and also their experiences.

Effect of systemic clarithromycin and prednisolone on histamine-induced otitis media in guinea pigs.

CONCLUSION: The results of the study showed that clarithromycin has anti-inflammatory and antioxidant effects and, when it is combined with prednisolone, those effects gain strength. OBJECTIVES: The present study aims to investigate the effects that the antioxidant and anti-inflammatory activities of clarithromycin and/or prednisolone have on experimental otitis media in effusion-induced guinea-pigs. METHOD AND RESULTS: In this study, 35-male guinea pigs were randomly divided into five-groups. For the experimental otitis media, intra-tympanic histamine (0.1 ml) was injected into the guinea pigs in all of the groups except the control group. Then, 24-h after the intra-tympanic injections, clarithromycin (15 mg/kg/day) and/or prednisolone (1 mg/kg/day) were applied intraperitoneally to the guinea-pigs for 7-days. The biochemical analysis showed an increase in antioxidant capacity and a decrease in oxidant status and malondialdehyde (MDA) levels in the clarithromycin group and the prednisolone group and especially in the clarithromycin+prednisolone group, as compared to the experimental group (p < 0.05). In the cytokine analysis, lower levels of interleukin (IL)-6 and IL-17A and higher IL-10 were found in the clarithromycin, prednisolone, and clarithromycin+prednisolone groups than in the experimental group (p < 0.05). Furthermore, the histologic analyses showed histopathologic changes in the middle ear mucosa of the experimental group, but comparatively fewer-histopathologic changes were observed in the clarithromycin, prednisolone, and clarithromycin+prednisolone groups.

The Relationship between the Localization, Size, Stage and Histopathology of the Primary Laryngeal Tumor with Neck Metastasis.

OBJECTIVE: In this study we aimed the investigate the laryngectomy (partial and total) and neck dissection (functional, radical) in patients undergoing larynx identified as a result of the operation of primary tumour localization, size, stage and histopathology of the relationship between neck metastasis. MATERIALS AND METHODS: The files of 118 patients who has had operation of laryngectomy (partly, total) and neck dissection (functional, radical) because of larynx cancer in the Ear Nose and Throat (ENT) Clinic in the last ten years (1997-2007) have been evaluated retrospectively. RESULTS: 116 of them were male and 2 of them were female. Age average was 56+/-22. 189 neck dissections have been applied to 118 patients. While in supraglottic tumours, 55.2% cervical metastasis and 28.9% occult metastasis have been determined, in transglottic tumours 35.1% cervical metastasis and 18.9% occult metastasis have been determined. It has been seen that while the cervical metastasis ratio of tumours bigger than 4 cm is 55.8%, the tumours smaller than 4 cm is 27.27% (p=0.002). The cervical metastasis rate has been determined as 26.3% in T1 cases, 25.8% in T2 cases, 40.6% in T3 cases and 58.3% in T4 cases. In tumours with advanced T stage, the rate of cervical metastasis has been seen more than the ones with early T stage (p=0.027). Cervical metastasis has been determined as 27.3% in good differential (G1) tumours, 53.4% in medium differential (G2) tumours, and 74.1% in bad differential (G3) tumours (p=0.005). CONCLUSION: Considered in the light of clinical parameters specified in the cervical lymph node metastasis, N0 patients with laryngeal cancer, tumour, according to the anatomical location as unilateral or bilateral elective neck dissection should be performed and histopathological specimens taken in the event of a positive detection of metastases concluded that postoperative radiotherapy should be performed.

Bone mineral density in patients with obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS. METHODS: Twenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1-L4), the femoral neck, and total femur region. RESULTS: No statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1-L4 t score, lumbar L1-L4 BMD, and femoral neck BMD values (p ≤ 0.001). We find significant correlations with lumbar L1-L4 BMD (r = -0.4; p = 0.023) and lumbar L1-L4 t score values (r = -0.5; p = 0.012). CONCLUSION: Our study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.

Glomuvenous malformations in the buccal area.

Glomuvenous malformations (GVMs) are relatively rare lesions in the head and neck area. A 30-year-old woman presented to our clinic with a large mass on the right buccal area with tenderness and hypersensitivity to palpation. The lesion was excised totally under general anesthesia. Microscopic evaluation and immunostaining method confirmed the diagnosis of GVM. We concluded that a solitary form of GVMs as a large mass on the buccal region could occur, and a mass with tenderness and hypersensitivity on palpation could be significant in its differential diagnosis.

Effects of rapid maxillary expansion with a memory palatal split screw on the morphology of the maxillary dental arch and nasal airway resistance.

The purpose of this study was to investigate the effects of rapid maxillary expansion (RME) with a memory palatal split screw on the morphology of the maxillary dental arch and nasal airway resistance (NAR). The material consisted of the rhinomanometric records and study models of 15 patients (8 females and 7 males) with mean age of 12.89 ± 1.20 years. Data were collected before expansion (T1), immediately after expansion (T2), and after a retention period of 6 months (T3). Maxillary expansion was completed within 8 days in all subjects. The data were analysed by analysis of variance. The least significant difference test was also used to determine between which periods the changes in the measurements were significant. Statistical analyses showed that NAR decreased (P < 0.01) and intermolar and interpremolar distances increased (P < 0.001) significantly at all observation periods, except between T2 and T3. RME using a memory palatal split screw is effective for improvement of nasal respiration via a widening effect on the nasal cavity.

Stereological evaluation of laryngeal cancers using computed tomography via the Cavalieri method: correlation between tumor volume and number of neck lymph node metastases.

Tumor volume is accepted to be a significant prognostic factor for cancers arising in the head and neck regions. There were few studies on laryngeal tumor volume calculations. The purposes of this study were (1) to describe and adapt the relevant methods of computed tomography and stereology to estimate laryngeal tumor volume measured by the Cavalieri method; (2) to examine the possible correlation between tumor size and the number of involved neck lymph nodes in patients with laryngeal malignancies; and (3) to investigate if there is left-right asymmetry for this correlation and the number of involved lymph nodes in bilateral laryngeal malignancies. Fifty-two patients with bilateral laryngeal cancer only from a total of 137 patients with laryngeal cancer who underwent neck dissection during the study period were included in the study. In all cases, neck dissection was part of the treatment of laryngeal cancer. The Cavalieri estimator was used to estimate the tumor volumes on computed tomographic images. The tumor volume increased with the number of involved lymph nodes in the bilateral laryngeal malignancies in both the right and left neck regions. In addition, the volume of the primary lesion and the number of lymph node metastases in the cancer cells in the right neck region were well correlated in patients with laryngeal cancer but not the number of lymph node metastases in the left neck region. Correct, unbiased, reliable volume measurements for staging and therapeutic decision making of laryngeal cancers via the Cavalieri method may be possible.

Sinonasal Burkitt lymphoma presenting as a nasal polyposis in a pregnant woman.

The incidence of Burkitt lymphoma (BL) during pregnancy is rare. We report a case of nasal BL with symptoms mimicking chronic rhinosinusitis and extensive unilateral polyposis in a pregnant woman. Functional endoscopic sinus surgery was performed. Histopathologic examination suggested a BL, and chemotherapy was initiated. She was not given radiotherapy. She has kept free of disease for 9 months since the completion of treatment. When a physician is confronted with unusual localization among the polypoid tissue described here, a complete differential diagnosis must be done.

Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty.

Snoring is a common complaint, especially among the elderly individuals. In the treatment of snoring, many options, surgical or nonsurgical, are available. In this randomized study, we used a modified technique including some components of radiofrequency-assisted uvulopalatoplasty (RAUP) and Uvulopalatopharyngoplasty UPPP (modified-RAUP, MRAUP) and RAUP in a control group. A total of 60 patients (58 male and 2 female), 30 in each group (MRAUP and RAUP groups), with an average age of 38 +/- 9 years were included in the study. In the MRAUP group, in addition to the modified surgery, preoperative steroid injection was used as a preemptive analgesic and pre-incisional steroid injection and closure of the edges of the incision were performed to achieve better relief of pain. Snoring score, pain at rest and during swallowing, analgesic consumption and speech score were evaluated using standard 10 cm visual analog scales (VAS). Operation time and other complications were recorded. The patients in the MRAUP group had better pain scores, both at rest and during swallowing, and less analgesic consumption. Although operation time was longer in the MRAUP group compared to that of the RAUP group, snoring score, evaluated from day 1 to the 6th month after operation, was significantly better in the MRAUP group. Postoperative speech scores at each visit were similar in both groups. In the MRAUP group, 87% of the patients (26 patients) had a final VAS for snoring below 3, while in the RAUP group 63% of the patients (19 patients) were below 3 on the scale (P < 0.05). Thus, MRAUP seems to be a promising technique for surgery as a treatment for snoring.

The effects of methylprednisolone and cefazolin sodium on antioxidant status in experimentally induced maxillary sinusitis.

CONCLUSION: Sinusitis is accompanied by deteriorated antioxidant status, which can be alleviated with administration of cefazolin sodium or methylprednisolone. Steroids improve sinusitis when combined with antibiotics. OBJECTIVE: To evaluate the antioxidant status in response to treatment of maxillary sinusitis with methylprednisolone and cefazolin sodium. MATERIALS AND METHODS: Twenty-eight rabbits were inoculated with Staphylococcus aureus and then treated with saline, methylprednisolone, cefazolin sodium, and methylprednisolone plus cefazolin sodium, twice daily for 7 days. After the animals were sacrificed, mucosa samples were obtained to determine catalase (CAT), superoxide dismutase (SOD), and glutathione reductase (GPx) activities and levels of nitric oxide (NO) and malondialdehyde (MDA). RESULTS: Catalase activity among untreated rabbits and those treated with either methylprednisolone or cefazolin sodium was not different. Activities of SOD and GPx were lower for rabbits treated with cefazolin sodium than for those treated with methylprednisolone and for untreated rabbits (p<0.0001). Rabbits treated with cefazolin sodium had lower NO and MDA levels than those treated with methylprednisolone and untreated rabbits (p<0.0001). Combined administration of cefazolin sodium with methylprednisolone increased CAT, SOD, and GPx activities further and decreased NO and MDA levels further in comparison with their administration alone (p<0.0001).

Treatment of sinusitis with corticosteroids in combination with antibiotics in experimentally induced rhinosinusitis.

OBJECTIVES: The objective of this study was to investigate the effects of corticosteroids, antibiotics, and their combination in the therapy of experimental bacterial rhinosinusitis. METHODS: Twenty-eight rabbits underwent experimental induction of bacterial rhinosinusitis with Staphylococcus aureus. The animals were assigned randomly to 1 of 4 treatments (saline solution, methylprednisolone, cefazolin sodium, methylprednisolone-cefazolin sodium) for 7 days. After the treatment period, sinus mucosa samples of the animals were examined stereologically. In addition, mucosa samples were used in the determination of myeloperoxidase (MPO) activity. RESULTS: Methylprednisolone, cefazolin, and methylprednisolone-cefazolin had a positive effect on the reduction of neutrophil infiltration to the sinus mucosa in experimental bacterial rhinosinusitis as compared to the group treated with saline solution. However, the effects of methylprednisolone, cefazolin, and methylprednisolone-cefazolin did not significantly differ (p > .05). Similarly, the use of methylprednisolone, cefazolin, and methylprednisolone-cefazolin decreased MPO activity as compared to the group with saline solution (p < .05), and the difference among methylprednisolone, cefazolin, and methylprednisolone-cefazolin was statistically significant (p < .05). The most significant decrease in MPO (neutrophil marker enzyme) activity was determined in the animals treated with methylprednisolone-cefazolin (p < .05). CONCLUSIONS: Administering corticosteroids as an adjunct to antibiotics may accelerate the healing process in experimentally induced rhinosinusitis. In this model of rhinosinusitis, an MPO assay was supportive of this hypothesis, although stereological examination showed no statistically significant difference.