Shrinkage of Nasal Mucosa and Cartilage During Formalin Fixation.

BACKGROUND: After resection, specimens are subjected to formalin fixation during histological processing. This procedure can result in tissue shrinkage, with the amount of shrinkage related to tissue composition and tissue type. AIMS: To evaluate the shrinkage of nasal mucosa and cartilage tissue and compare differences in shrinkage after resection, after formalin fixation, and during microscopic examination to understand differences in the rate of shrinkage of different tissue types. STUDY DESIGN: Animal experimentation. METHODS: Fresh nasal septa were excised from sheep (10 mm diameter in 40 sheep and 20 mm diameter in 40 sheep). The mucosa was separated from one side of the cartilage, with the contralateral mucosa remaining attached to the cartilage. Specimen diameters were measured in situ, after resection, after fixation for 6 or 24 hours (10% formalin), and during microscopic examination. RESULTS: There were no differences between the in situ and after resection diameters of any tissue components (free mucosa, mucosa attached to cartilage, and cartilage) of all nasal specimens (10- or 20-mm diameter and 6- or 24-hour fixation). However, significant shrinkage occurred between resection and after-fixation. Regarding tissue specimens that were fixed for different durations (6 or 24 hours), we observed a significantly smaller mean tissue diameter in specimens fixed for 24 hours versus those fixed for 6 hours for mucosa attached to cartilage (in the 10-mm diameter after-fixation samples), free mucosa (in the 20-mm diameter after-fixation samples), mucosa attached to cartilage (in the 20-mm diameter after-fixation and microscopic measurement samples), and cartilage (in the 20-mm diameter after-fixation samples). Tissue shrinkage was greatest in free mucosal tissue and least in cartilage. CONCLUSION: These results should be considered when evaluating patients undergoing surgical procedures for nasal cavity and paranasal sinus malignancies. Surgical margins should be measured before fixation or evaluated if possible before fixation and shrinkage.

Congenital cholesteatoma together with ossicular chain anomaly.

Cholesteatomas that occur under an intact tympanic membrane in the absence of prior surgical procedures or perforation are defined as congenital cholesteatomas. These entities are rarely seen, because they do not cause any major symptoms unless they touch the ossicular chain. Likewise, isolated congenital ossicular anomalies that occur independently of external ear anomalies and craniofacial dysplasia are also rarely seen. Here, we report a patient who presented with congenital cholesteatoma associated with anomalies of the ossicular chain and discuss its pathogenesis.

Relation of Actinomyces with Tonsillar Hypertrophy and Antibiotic Use.

OBJECTIVE: This study aimed to investigate the incidence of Actinomyces in tonsillar tissues of patients undergoing tonsillectomy and to determine the association among tonsillar volume, preoperative antibiotic use, and presence of Actinomyces in tonsil tissues. METHODS: In this study, 142 patients who underwent tonsillectomy in last four years were included. Of the total patients, 97 (66.9%) were children and 47 (33.1%) were adults. The patients' age, sex, preoperative antibiotic use, tonsillar volume, and presence of actinomyces in tonsillar tissues were recorded. RESULTS: Actinomyces was identified in tonsillar tissues of 16 (16.4%) pediatric and 21 (44.6%) adult patients. Of all pediatric patients positive for Actinomyces, 13 were males and three were females whereas of all adult patients positive for actinomyces, 14 were males and seven were females. Tonsillar tissue volumes in both pediatric and adult patients positive for Actinomyces were statistically higher than the Actinomyces negative ones. Antibiotic use was higher and the incidence of Actinomyces was lower in pediatric patients than in adult patients positive for Actinomyces. CONCLUSION: Our study results revealed that Actinomyces was prominent in adult patients with tonsillar hypertrophy. In addition, the frequent use of antibiotic decreased the incidence of Actinomyces in tonsillar tissues.

[The relationship between passive rhinomanometry measurements in sitting and supine position and obstructive sleep apnea syndrome]. / Oturur ve sirtüstü pozisyonda pasif rinomanometri ölçümleri ve tikayici uyku apne sendromu ile iliskisi.

OBJECTIVES: This study aims to investigate the possible relationship between passive rhinomanometry measurements in sitting and supine position and obstructive sleep apnea syndrome. PATIENTS AND METHODS: Between January 2011 and December 2013, 88 male patients (mean age 46.8 years; range 18 to 79 years) underwent passive rhinomanometry in sitting and supine position following history, physical examination and fiberoptic endoscopic examination. 1.5 lt/sn air flow was pumped into the nose of each patient via a silicone nasal mask. Meanwhile, flow and pressure values were measured. RESULTS: There was no correlation between the resistance values and apnea hypopnea index (AHI) scores and polysomnography and physical examination parameters (p>0.05). The differential resistance was correlated with AHI (r=0.325, p<0.05), body mass index (r=0.324, p<0.05), neck circumference (r=0.421, p<0.01), waist circumference (r=0.444, p<0.01), modified Mallampati score (r=0.356, p<0.05), and retropalatal grade (r=0.438, p<0.01). CONCLUSION: The correlation between the differential resistance and physical examination parameters and AHI scores support the hypothesis that position-related retropalatal segment alterations can be measured by passive rhinomanometry while awake.

Sex differences in adult craniofacial parameters.

PURPOSE: To compare normal male and female craniofacial parameters in adults and evaluate associations of sex and intercochlear distance with other craniofacial parameters. METHODS: In 60 normal adults (30 men and 30 women) who had no otitis media, craniofacial parameters were measured retrospectively on two-dimensional reformatted computed tomography scans. RESULTS: Compared with women, men had significantly greater mean osseous auditory tube length, cartilaginous auditory tube length, mastoid length, intercochlear distance, sella to posterior nasal spine distance, sella to basion distance, and nasopharynx sagittal area. The intercochlear distance was significantly correlated with mastoid depth, midpoint of the pharyngeal opening distance, sella to nasion distance, and nasopharynx sagittal area and inversely with angle of the auditory tube. Most men and women had Körner septum present, and mean thickness of Körner septum was significantly greater in men than women. CONCLUSIONS: Some craniofacial parameters, especially vertical parameters, differ with sex. These differences begin in childhood and continue in adulthood. Sex must be considered when planning a craniofacial morphologic study, and results of a craniofacial morphologic study should be evaluated with caution when there is no sex matching of the patient and control groups.

Benign paroxysmal positional vertigo after nonotologic surgery: case series.

Benign paroxysmal positional vertigo is one of the most common types of vertigo caused by peripheral vestibular dysfunction. Although head trauma, migraine, long-term bed rest, Ménière disease, viral labyrinthitis, and upper respiratory tract infections are believed to be predisposing factors, most cases of benign paroxysmal positional vertigo are idiopathic. Ear surgery is another cause, but after non-otologic surgery, attacks of benign paroxysmal positional vertigo are rare. We describe three cases of benign paroxysmal positional vertigo attacks after non-otologic surgery (one patient after a nasal septoplasty and two patients after dental endodontic treatment) and discuss the pathophysiological mechanism of benign paroxysmal positional vertigo seen after non-otologic surgery, its diagnosis and treatment.

Sudden hearing loss after dental treatment.

A 66-year-old man presented with impaired balance, tinnitus, sensation of blockage, and hearing loss in his left ear, which developed after dental treatment for dental pain 4 days previously. Treatment of the carious left upper second molar tooth had included pulp extirpation, canal expansion, and tooth filling under local anesthesia with articaine and epinephrine. Impaired balance decreased spontaneously within 3 days of dental treatment, but tinnitus and hearing loss persisted. Pure tone audiogram showed profound sensorineural hearing loss in the left ear, with a downslope from 40 to 100 dB, and an abnormal speech discrimination score (50%). Treatment included intravenous prednisolone, intratympanic dexamethasone, and oral betahistine and trimetazidine. The patient had improved hearing and resolution of tinnitus. Sudden hearing loss is rare after dental treatment, and awareness of this complication may prompt early referral for treatment and may improve recovery and prognosis.

Idiopathic incus necrosis: Analysis of 4 cases.

We evaluated ossicular chain reconstruction in patients with idiopathic incus necrosis who have conductive hearing loss and an intact ear drum. The study included four patients (3 women and 1 man; the ages of the patients were 22, 31, 35, and 56 years, respectively) with unilateral conductive hearing loss, no history of chronic serous otitis media, an intact ear drum, normal middle ear mucosa, and necrosis of the long processes of the incus. On preoperative pure tone audiometry, air-bone gaps were 24, 25, 38, and 33 dB. Bilateral tympanometry and temporal bone computed tomography results were normal. All 4 patients underwent an exploratory tympanotomy. During the operation, the mucosa of the middle ear was normal, with a mobile stapes foot plate and malleus. No evidence of any granulation tissue was found; however, necrosis of the incus long processes was seen. For ossicular reconstruction, we used tragal cartilage between the incus and the stapes in 1 patient; in the other 3 patients, glass ionomer bone cement was used (an interposition cartilage graft also was used in the patients who received the glass ionomer bone cement). In all patients, air-bone gaps under 20 dB were established in the first year after surgery. In the ossicular disorders within the middle ear, the incus is the most commonly affected ossicle. While, the most common cause of these disorders is chronic otitis media, it may be idiopathic rarely. Several ossicular reconstruction techniques have been used to repair incudostapedial discontinuity.

Herpes zoster oticus (Ramsay Hunt syndrome) in children: case report and literature review.

INTRODUCTION: Approximately 10% of patients with peripheral facial nerve palsy are children. Facial nerve palsy is usually idiopathic. An uncommon cause is herpes zoster oticus (Ramsay Hunt syndrome). This syndrome usually affects adults and is rare in children. METHODS: We reviewed the literature and describe the cause, clinical manifestations, and treatment of Ramsay Hunt syndrome. We also report a case of the syndrome in a 12-year-old boy. CONCLUSION: Ramsay Hunt syndrome is characterized by peripheral facial paralysis associated with herpetic eruption on the auricula and external ear, and by vestibulocochlear dysfunction. It occurs by reactivation of latent varicella-zoster virus (VZV) in the geniculate ganglion, affecting the seventh and eighth cranial nerves. The diagnosis is based on history and physical findings. Treatment of Ramsay Hunt syndrome uses a combination of high-dose corticosteroids and acyclovir. Although the prognosis is better in children than in adults, it is not good enough.

Hypopharyngeal cancer in a pregnant woman.

Cancer in pregnant women is a very difficult clinical condition that profoundly affects patients and their families, as well as the medical staff who provide their care. Diagnostic and therapeutic decisions must balance adequate treatment and fetal risk. In developed societies, cancer in pregnant women has become more common during the last 30 years because of an increase in the number of relatively older women who give birth. The most common malignancies in pregnant women are melanoma; lymphoma; leukemia; and breast, cervical, ovarian, gastrointestinal, and genitourinary cancers. Cancer of the head and neck in pregnant patients is very rare. In this article, we describe a rare case of advanced squamous cell carcinoma of the hypopharyngeal area in a young pregnant woman, and we discuss the diagnosis and treatment of cancers of the head and neck in pregnant patients.

Atypical presentation of antrochoanal polyp in a child.

Antrochoanal polyp is a benign, solitary polypoid lesion arising from the edematous mucosa of the maxillary sinus and extending through the maxillary ostium into the nose. In children, it constitutes 33% of all nasal polyps. It presents most commonly with unilateral nasal obstruction and purulent rhinorrhea. Surgery is the usual treatment for antrochoanal polyps. The primary aim of treatment for antrochoanal polyp must be complete removal with total cleaning of the maxillary sinus. In this article, we present a case of a 13-year-old boy with an antrochoanal polyp who complained of difficulty in breathing and swallowing; the differential diagnosis of nasopharyngeal masses and the treatment of antrochoanal polyps in children are also discussed. Antrochoanal polyps present most commonly with unilateral nasal obstruction; however, they sometimes present atypically. Clinical manifestations may mimic other neoplasms in the nasal cavity and nasopharynx. Nasopharyngeal masses must be evaluated by endoscopic examination and radiologic imaging before surgery to avoid unnecessary and harmful surgical techniques. Reporting this case is important to direct attention of the Ear, Nose and Throat specialist and pediatricians when facing similar cases.

Protective effects of pentoxifylline and nimodipine on acoustic trauma in Guinea pig cochlea.

OBJECTIVE: To examine the protective effects of the vasodilator and hemorheologically active drug pentoxifylline and the calcium channel blocker nimodipine on the cochlea after acoustic overexposure in guinea pigs. METHODS: Eighteen guinea pigs were used. The animals were divided into 5 groups: 1) control, 2) acoustic trauma, 3) nimodipine plus acoustic trauma, 4) pentoxifylline plus acoustic trauma, and 5) pentoxifylline plus nimodipine plus acoustic trauma. Nimodipine was given to the guinea pigs 3 mg/kg intraperitoneally in a single dose; pentoxifylline was given 150 mg/kg in a single dose intraperitoneally. A gunnery range was used to create acoustic trauma. The auditory brainstem response of each guinea pig was determined first; then, the animals were killed, and their cochleas were examined under an electron microscope. RESULTS: In the acoustic trauma group, negative auditory brainstem response potentials were seen as was well-adjusted cellular damage to the organ of Corti. In the pentoxifylline group, near-normal auditory brainstem response recordings and organ of Corti histologic findings were found. Organ of Corti damage was seen in the pentoxifylline plus nimodipine plus acoustic trauma group. CONCLUSION: We determined that pentoxifylline was highly protective against noise, but nimodipine was not. Also, pentoxifylline and nimodipine, when used together, increased damage to the organ of Corti.

Closure of oroantral fistula with the septal cartilage graft.

For the closure of oroantral fistula, many techniques have been described. There are advantages and disadvantages of all these techniques. We present a technique in which nasoseptal cartilage graft is used for the closure of the oroantral communication.

Craniofacial measures of chronic otitis media patients by 2D reformatted CT.

Few authors have studied differences in craniofacial morphology of adults with chronic otitis media (COM). We sought to compare the craniofacial measurements of patients with COM with otherwise healthy adults. The study group included 120 adult patients. The control group had 30 men and 30 women without evidence of otitis media; a COM group consisted of 30 men and 30 women with COM. Craniofacial measurements were assessed retrospectively using a two-dimensional reformatted CT method. Multiple linear (bony and cartilaginous auditory tube length, size of the mastoid, height of the jugular bulbus, intercochlear distance, bitemporal distance, distance between pharyngeal orifices, and some cephalometric cranial base distances), angular (auditory tube angle, cranial base angle), and area (axial and sagittal nasopharynx size) measurements were performed. In addition, petrosquamosal (Körner's) septum prevalence and size were evaluated. No statistically significant differences were found regarding craniofacial variables except mastoid size (mastoid depth and length). None of the craniofacial parameters showed significant differences between adults with COM and adults without evidence of otitis media, when age, sex, and race were considered. No statistically significant differences were found when mastoid size was compared with unilateral and bilateral COM. No statistically significant difference was found between mastoid size of the intact side and involved side of the unilateral patients with COM. Patients with unilateral and bilateral COM may be in the same group, genetically or environmentally, as far as mastoid size is concerned. Small mastoid size correlates with COM, but development of clinical disease should be under the control of different factors.

Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo.

CONCLUSIONS: Recurrence of posterior canal benign paroxysmal positional vertigo (PC-BPPV) developed in one-third of patients when followed for an average of 5 years from diagnosis. History of head trauma and Ménière's disease contributed significantly to recurrence (p < 0.05). History of head trauma as an etiologic cause was more frequent in patients with recurrence of PC-BPPV. OBJECTIVES: To estimate recurrence in the long-term follow-up of patients with PC-BPPV after successful canalith repositioning maneuvers, and to determine which factors contribute to recurrence. METHODS: The charts of 118 patients with PC-BPPV were reviewed. Data of patients were recorded from the initial evaluation and treatment. Follow-up was performed at mean of 64 +/- 7.7 months after the initial phase. The Dix-Hallpike maneuver was performed for diagnosis, and all patients were treated by the canalith repositioning maneuver, which was repeated every 3 days until the patients were symptom-free or results of the Dix-Hallpike maneuver were negative. RESULTS: At diagnosis, the most common etiology was idiopathic in 55 patients (46.6%). Recurrence occurred in 39 of 118 patients (33.1%). Recurrence occurred within the first 2 years in 21 of the 39 patients (53.8%). History of head trauma was a more frequent finding in patients who developed recurrence (12 of 39, 30.8%).

[Endoscopic treatment of idiopathic spontaneous although cerebrospinal fluid rhinorrhea: a case report]. / Idyopatik spontan beyin omurilik sivisi rinorenin endoskopik tedavisi: Olgu sunumu.

Although cerebrospinal fluid (CSF) rhinorrhea is a rarely seen clinical entity, it is a condition which should be considered carefully by otolaryngologists and neurosurgeons because it has the possibility of serious complications unless it is treated. Trauma is the most common causative factor. Idiopathic spontaneous CSF rhinorrhea is a very rare entity which is difficult to manage and which has high recurrence rates. Although in the past CSF rhinorrhea used to be treated by intracranial route, nowadays endonasal endoscopic surgery is preferred because of wide usage of rigid endoscopes with much fewer complications, In this article, a case of 43-year-old female with idiopathic spontaneous CSF rhinorrhea repaired by endonasal endoscopic surgery is presented, and the diagnosis and the treatment of CSF rhinorrhea is reviewed.

Comparison of surgical outcomes of endonasal dacryocystorhinostomy with or without mucosal flaps.

OBJECTIVE: The goals of this study were to evaluate the long-term results of endoscopic endonasal dacryocystorhinostomy (DCR) with or without a posterior mucosal flap and to compare the surgical success rates of that procedure in patients with a nasolacrimal duct obstruction. PATIENTS AND METHODS: We retrospectively investigated the results of 78 endoscopic endonasal DCRs performed at the Baskent University, Department of Otolaryngology between December 2000 and March 2007 on 74 patients with a lacrimal obstruction. The patients were divided into two groups. During surgery, the posterior mucosal flap was preserved in 27 patients (group A) and removed in 47 patients (group B). All patients underwent intubation with a silicone tube at the conclusion of surgery. The silicone tube was removed within 6 months after surgery. The mean follow-up period was 36 months (range, 2-78 months). The results obtained were then compared. RESULTS: Granulation tissue and synechia developed between the lateral nasal wall and the middle turbinate in one patient in group A (revision surgery was not required). In group B, granulation tissue at the rhinostomy opening was found in seven patients, and in four of those subjects, the granulation tissue obstructed the neo-ostium. These four patients underwent a second operation. In group B, synechia was noted between the middle turbinate and the lateral nasal wall in two of 47 patients. In group A, the procedure was successful for all patients except one in whom granulation tissue developed, and in group B, the surgical success rate was 88.3%. CONCLUSION: In endoscopic endonasal DCR, the closure of bare bone with a posteriorly based nasal mucosal flap that creates an anastomosis between the lacrimal sac mucosa and the nasal mucosa decreases the formation of granulation tissue. But, there is no significant difference of success rate between two groups.

[A case of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms]. / Kokleovestibüler semptomlarin ön planda oldugu herpetik fasyal paralizi: Olgu sunumu.

A 42-year-old man presented with sensorineural hearing loss of acute onset, tinnitus, and vertigo. Physical examination revealed slight asymmetry in facial nerve functions and spontaneous nystagmus. Magnetic resonance imaging of the internal acoustic canal showed contrast enhancement consistent with edema-inflammation, being notable and diffuse in the seventh and eighth cranial nerve complex, and minimal in the cochlea. Non-hydropic cochleovestibular syndrome was considered and the patient was treated with antiviral and corticosteroid medications. A week later, facial paralysis improved and the acute hearing loss reversed. On the twelfth day of presentation, he had no complaints other than mild imbalance on abrupt changes in movement. In this type of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms, it might be argued that varicella zoster virus reactivation occurs in the spiral and/or vestibular ganglion.

Case report and surgical solution for nasal spine agenesis in a woman with Binder syndrome.

Binder syndrome is an uncommon disorder of unknown etiology. It is characterized by hypoplasia of the nose and maxilla and altered morphology of the associated soft tissue. We report a 19-year-old Binder syndrome patient with short-nose deformity and anterior nasal spine agenesis. We present a surgical technique for nasal spine agenesis treatment. We used a titanium screw without a graft, which supported the nasal tip and increased tip projection. As there is good soft-tissue coverage over the screw, infection or extrusion was not encountered, and the patient had no complaints 1 year after surgery.