Is Gestational COVID-19 a Risk Factor for Congenital Hearing Loss?

OBJECTIVE: The aim of this study was to investigate whether COVID-19 during pregnancy is a risk factor for congenital hearing loss. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Hearing screening test results of 60,223 newborns between March 2020 and May 2021 were screened using the national database. Newborn babies of 570 pregnant women with positive COVID-19 PCR test during pregnancy who met the study criteria were included in the gestational COVID-19 group, and 570 healthy newborns born in the same period were included in the control group. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Results of up to three automatic auditory brainstem response tests in the first 30 days of life were used for newborn hearing screening. RESULTS: When the gestational COVID-19 and control groups were compared in terms of demographic data, there was no statistically significant difference for any of the variables (maternal age, gestational age, birth weight, neonate gender, mode of delivery, p > 0.05 for all variables). Of the mothers in the gestational COVID-19 group, 62 (10.9%) had COVID-19 in the first trimester, 181 (31.8%) in the second trimester, and 327 (57.3%) in the third trimester. When the first and second test results of newborn hearing screening were compared between the groups, the number of babies with hearing loss was higher in the gestational COVID-19 group than in the control group (p = 0.025; odds ratio, 1.357; 95% confidence interval, 1.039-1.774; p = 0.006; odds ratio, 4.924; 95% confidence interval, 1.410-17.193, respectively). For the third test results, hearing loss was detected in only one baby in both groups (p = 0.284). When the first, second, and third test results for newborn hearing screening were compared according to the trimesters when COVID-19 positivity was identified, the difference between trimesters was not found to be statistically significant (p > 0.05). CONCLUSION: To the best of our knowledge, this is the largest study in the literature of the impact of COVID-19 on newborn hearing. The findings in the study suggest that gestational COVID-19 is not a risk factor for permanent congenital hearing loss. However, because the risk of detecting hearing loss is high in the first 15 days, we emphasize the importance of the third screening test.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer / Valor prognóstico de parâmetros de PET/TC com 18F-FDG e variáveis histopatológicas em câncer de cabeça e pescoço

Abstract Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Resumo Introdução Os parâmetros da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose, como os máximos valores de captação padronizados, o volume metabólico tumoral padrão e a glicólise total da lesão são importantes biomarcadores prognósticos de câncer. Objetivo Investigar o valor prognóstico desses parâmetros em pacientes com câncer de cabeça e pescoço. Método Fizemos um estudo retrospectivo que incluiu 47 pacientes com câncer de cabeça e pescoço e que foram submetidos à tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose antes do tratamento. Volume metabólico tumoral, glicólise total da lesão e valores de captação padronizados foram aferidos em cada paciente. O valor prognóstico de parâmetros quantitativos da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose e das variáveis clínico-patológicas sobre a sobrevida livre de doença e a sobrevida geral foi analisado. Resultados A média (intervalo) de volume metabólico tumoral e glicólise total da lesão e valores de captação padronizados foram 7,63 cm3 (0,6-34,3), 68,9 g (2,58-524,5) e 13,89 g/mL (4,89-33,03), respectivamente. Metástase nos nódulos linfáticos e diferenciação tumoral foram variáveis significativas de sobrevida livre de doença e sobrevida geral; contudo, nenhum parâmetro da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose estava associado a sobrevida livre de doença e sobrevida geral. Conclusão As quantidades dos parâmetros da tomografia por emissão de pósitrons pré-tratamento não previram a sobrevida em câncer de cabeça e pescoço.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer.

INTRODUCTION: 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. OBJECTIVE: To investigate the prognostic value of these parameters in patients with head and neck cancers. METHODS: We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. RESULTS: The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm3 (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. CONCLUSION: Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Internal Nasal Valve Expanding Graft for Middle Vault Reconstruction.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre- and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P < 0.05). Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < 0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

Lymph Node Density in Node-Positive Laryngeal Carcinoma: Analysis of Prognostic Value for Survival.

OBJECTIVE: We investigated the value of lymph node density (LND) as a predictor of survival in patients with laryngeal squamous cell carcinoma (SCC) and positive neck node (pN+) after laryngectomy. STUDY DESIGN: Case series with chart review. SETTING: Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECTS AND METHODS: We reviewed the records of 289 patients with newly diagnosed primary laryngeal carcinomas who underwent partial or total laryngectomy and combined neck dissection at a tertiary referral center between June 2006 and December 2014. Patients with pN+ laryngeal SCC (n = 101) were included in the study. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of LND. RESULTS: In 101 patients with pN+ laryngeal SCC, LND ≥0.09 and number of metastatic lymph nodes >4 were significantly associated with OS and DFS but not the overall tumor, node, and metastasis stage. Forward stepwise Cox regression analysis revealed that LND ≥0.09 was the only independent predictor of both DFS and OS. Furthermore, the odds ratio of LND ≥0.09 was 10 times higher in patients with regional recurrence when compared patients without regional recurrence. CONCLUSIONS: LND was the only independent prognostic predictor of OS and DFS in patients with pN+ laryngeal SCC. Moreover, patients with LND ≥0.09 were significantly associated with high risk of regional recurrence. Thus, patients with LND ≥0.09 are at high risk of regional recurrence and death and may be considered for adjuvant chemoradiation.

[Repair of incus long arm defects by hydroxyapatite bone cement]. / Inkus uzun kol defektlerinin hidroksiapatit kemik çimento ile onarimi.

OBJECTIVES: This study aims to evaluate our ossiculoplasty results using hydroxyapatite bone cement. PATIENTS AND METHODS: Data of 29 patients (16 males, 13 females; mean age 28 years; range 17 to 57 years) who were performed ossiculoplasty using hydroxyapatite bone cement in Izmir Katip Çelebi University Atatürk Training and Research Hospital Department of Otorhinolaryngology between January 2010 and December 2013 were retrospectively evaluated. Of the 29 operated patients, bone cement was administered in 23 patients during tympanoplasty, in two patients during open technique tympanomastoidectomy, and in four patients during exploratory tympanotomy. Hydroxyapatite bone cement was only used to repair defects between incus and stapes no longer than one third of incus long arm length. Mean follow-up time was 6.5 months (range 2-32 months). RESULTS: Success of ossiculoplasty was evaluated by Belfast 15/30 dB rule of thumb. Preoperative air-bone gap was 45.1 dB (range 35-55) and postoperative air-bone gap was 17.7 dB (range 6-40). Air-bone gap was below 10 dB in six patients, between 10-20 dB in 14 patients, between 20-30 dB in seven patients, and between 30-40 dB in two patients. CONCLUSION: Ossiculoplasty using hydroxyapatite bone cement is a safe and effective method for the repair of particularly small incus long arm defects.

Relationships between facial canal dehiscence and other intraoperative findings in chronic otitis media with cholesteatoma.

OBJECTIVE: We investigated the relationship between facial canal dehiscence and intraoperative middle ear and mastoid findings in patients operated on for cholesteatoma. METHODS: We examined retrospectively 334 patients who had been operated on for cholesteatoma in Izmir Katip Celebi University, Ataturk Research and Training Hospital, ENT Clinic, between April 1997 and April 2010. The patients were examined for facial canal dehiscence according to age, gender, side of the ear, surgery type, first or revision surgery, localization of the facial canal dehiscence, spread of the cholesteatoma, with the presence of lateral semi-circular canal (LSCC) fistula and any defect in the ossicle chain, and destruction in the posterior wall of the external auditory canal(EAC). RESULTS: Of the patients, 23.6% had facial canal dehiscence and detected most commonly in the right ear 28.9% and tympanic segment, 83.5%. Facial canal dehiscence was found to be 24.2-fold more common in patients with LSCC fistula and 4.1-fold more common in patients with destruction in the posterior wall of the (EAC). In patients located cholesteatoma in tympanic cavity+antrum and the tympanic cavity+all mastoid cells and with incus and stapes defect, increased incidence of dehiscence. Age, first or revision operation and canal wall down tympanoplasty (CWDT) or canal wall up tympanoplasty (CWUT) did not affect the incidence of dehiscence. CONCLUSIONS: That the likelihood of facial canal dehiscence occurrence is increased in patients with LSSC fistulas, destruction in the posterior wall of the EAC, or a stapes defect is important information for surgeons.

Results of decompression with middle cranial fossa approach or traumatic intratemporal fascial nerve injury.

OBJECTIVE: To present the results of the traumatic intratemporal facial nerve injury that have undergone facial nerve decompression by using middle cranial fossa (MCF) approach. STUDY DESIGN: A retrospective study SETTING: Tertiary referral center PATIENTS AND METHODS: In this study, 13 patients who developed facial paralysis due to temporal bone trauma and undergone decompression by using MCF approach in Department of Otorhinolaryngology of Izmir Katip Celebi University Research and Training Hospital between January 1993 and December 2012 were presented retrospectively. Patients were assessed in terms of side, etiology, fracture type, House-Brackmann (HB) grade, electroneuronography (ENOG), electromyography (EMG), hearing loss, operation time, and the region of the injury. RESULTS: The fracture was at the right side in 7 (53.8%) and at the left side in 6 patients (46.1%). The type of temporal bone fracture was longitudinal in 6 (46.1%), transverse in 2 (15.3%), and mixed in 5 patients (38.4%). Total axonal degeneration in EMG and ENOG were seen in all patients, who were HB grade 6 at preoperative assessment. Mean operation time was 30 days. The lesion in all patients was at the region of geniculate ganglion. There was conductive hearing loss in 7 patients (53.8%), sensorineural in 4 (30.7%), and mixed in 1 patient (7.6%); hearing was normal in 1 patient (7.6%). Seven patients (53.8%) improved to HB grade 2. CONCLUSION: In the light of the information obtained from HRCT, ENOG, and EMG, we believe that better results can be achieved with facial nerve decompression that is performed before 1 month, and geniculate ganglion region may be better controlled by MCF approach.

Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results.

CONCLUSIONS: Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique is an effective and durable procedure for the management of patients with bilateral vocal fold immobility. OBJECTIVES: To review the long-term results of bilateral vocal fold immobility in 26 patients treated with vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique over a 6-year period. METHODS: This retrospective study examined patients with a minimum follow-up of 1 year. The main outcome measures used were the modified Medical Research Council (MRC) dyspnoea scale and the assessment of voice quality pre- and postoperatively using the Likert method. RESULTS: The mean follow-up period was 23.77 ± 12.01 months. All patients reported marked symptomatic improvement in dyspnoea (p = 0.0001). The voice quality worsened as expected; however, this difference did not reach a significant level (p = 0.642). Transient microaspiration was noted in seven of the patients and resolved in 1 or 2 days. The procedure was performed for the contralateral vocal fold in one case, due to the loss of suture tension. No patient showed aspiration postoperatively or during follow-up. All patients were regularly followed up for the beginning of movement of the lateralized or contralateral vocal folds in our outpatient clinic.

Postintubation laryngotracheal stenosis: assessing the success of surgery.

OBJECTIVE: This study evaluated the outcome in adult patients with laryngotracheal stenosis (LTS) and assessed the effect of procedures on their quality-of-life scores. METHODS: The study included 15 adult patients with LTS (11 males [73.3%], 4 females [26.7%]; mean age, 32 years [range, 10-52 years]) treated at the Department of Otolaryngology Head and Surgery Clinic, Izmir Atatürk Research Hospital, Turkey, from 1997 to 2008. Success of the surgery is evaluated by decanullation rate, Short form-36 (SF-36), and the Medical Research Council dyspnea scale. RESULTS: The etiology of the LTS was intubation related in 14 cases (93.3%) and idiopathic in 1 case. According to the Myers-Cotton classification, 2 (13%), 8 (54%), and 5 (33%) patients were at stages 2 to 4, respectively. Fourteen patients had a mean follow-up of 57 months (range, 24-256 months). The stenotic segment involved 1 to 3 cm (mean, 1.7 cm) of trachea, and 2 to 5 tracheal rings (mean, 3.1) were resected. Postoperative decannulation was achieved in 13 patients (86.6%). In the short form-36 questionnaire, all of the parameters except for "role-emotional" were found to be significant (P < 0.01). The Medical Research Council dyspnea scale assessment revealed a significant (P < 0.001) decrease postoperatively. CONCLUSIONS: Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected cases of advanced stenosis.

Hearing loss effects of administering boric alcohol solution prepared with alcohol in various degrees on guinea pigs (an experimental study).

OBJECTIVE: To investigate the ototoxic effect of boric acid solution prepared with different degree of alcohol. METHODS: This study was performed on 28 young albino guinea pigs. After the animals divided four groups prior to the application of the solution an auditory brainstem response (ABR) test was applied to the each animal under general anesthesia. Their tympanic membranes perforated and test solutions were administrated to the middle ear through the perforation. On 15th day, ABR measurements were carried out and comparison was made with preadministration values. RESULTS: The degrees of hearing loss occurring as a result of the administration of 4% boric alcohol solutions prepared with 60° and 40° alcohol differed significantly (p < 0.001). CONCLUSION: It was established that 4% boric acid solution prepared with 60 alcohol affected hearing in guinea pigs more negatively and an increase in degree of alcohol also increased the ototoxicity of the boric acid solution.

Synovial sarcoma of the infratemporal fossa with intracranial extension.

Synovial sarcomas (SS) account for 7-8% of soft-tissue cancers and 3-5% of all cases with head and neck involvement. Synovial sarcoma of the infratemporal fossa is very rare In this article, we report the fourth case of SS of infratemporal fossa and the first case with intracranial extension via the foramen ovale. A 31-year-old man admitted with a one-year history of intense pain in his right jaw. On physical examination, there was only hyperesthesia over the right mandible side. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a mass in the infratemporal fossa and intracranial extension from the foramen ovale. The mass was surgically removed en bloc. Postoperative pathological examination reported the mass as a biphasic-type synovial sarcoma. The patient who received postoperative chemoradiotherapy had no recurrent disease for one year. The patient is still being followed in our clinic.

Conquering the castle: a novel technique for the middle fossa approach in facial decompression.

OBJECTIVE: To describe 2 subapproaches of the middle fossa approach: the transillumination method and transection of lines using the foramen spinosum, greater superficial petrosal nerve, and trigeminal impression to locate the malleus head for safe identification and decompression of the geniculate ganglion and facial nerve. STUDY DESIGN: Cadaver study. SETTING: A tertiary university hospital anatomy laboratory. SUBJECTS AND METHODS: The present study was conducted using 7 formalin-fixed cadaver heads (14 sides). A 0° endoscope was introduced into the external ear canal toward the posterosuperior quadrant of the tympanic membrane, after which transillumination was used to locate the malleus head. The brightest point indicated the convergence of the greater superficial petrosal nerve and a line drawn along the superior semicircular canal. An additional line was drawn parallel to the petrous ridge from the foramen spinosum and along the pathway of the greater superficial petrosal nerve. A third line connected the trigeminal impression to the zygomatic root. The area posterior to the intersection of these 2 lines separately with the third line was considered the zone of location of the malleus head. Among 17 patients undergoing surgery for facial paralysis between 1993 and 2011, transillumination was used in 6 patients to identify the malleus head to locate the geniculate ganglion. RESULTS: These techniques were proven to be reliable in locating the malleus head to find the geniculate ganglion in 14 dissected cadaveric temporal bones. CONCLUSION: Two methods of locating the malleus head for facial decompression were defined.

Prevention of cisplatin ototoxicity: Efficacy of micronized flavonoid fraction in a guinea pig model.

OBJECTIVE: To evaluate the effectiveness of micronized flavonoid fraction in preventing cisplatin ototoxicity in a guinea pig model. METHODS: This study was conducted on 23 guinea pigs in the Animal Laboratory of Izmir Atatürk Training and Research Hospital. Animals were divided into three groups: Group 1 consisted of eight animals receiving cisplatin only; Group 2 contained eight animals receiving cisplatin+micronized flavonoid fraction; and Group 3 contained seven animals that received micronized flavonoid fraction only. Their cochlear reserve was evaluated by measuring the distortion product otoacoustic emission on days 0 and 7. RESULTS: In Groups 1 and 2, the intragroup signal-noise ratios were statistically different at all frequencies tested (based on negative ranks, p<0.05). In Group 3, the intragroup signal-noise ratios did not differ significantly at the frequencies tested (p>0.05). Comparison of the three groups showed statistically significant differences among the groups (p<0.05). The post hoc Bonferroni correction showed statistically significant differences among all three groups (p<0.016). The median signal-noise ratio of the three groups tended to increase (z-value was positive for all the frequencies tested; p<0.01). CONCLUSION: Micronized flavonoid fraction (Daflon) is effective against cisplatin-induced ototoxicity in guinea pigs.

Increased expression of VEGF, iNOS, IL-1ß, and IL-17 in a rabbit model of gastric content-induced middle ear inflammation.

OBJECTIVE: To investigate the histopathological changes and the expression of vascular endothelial growth factor (VEGF), inducible NO-synthase (iNOS), endothelial NO-synthase (eNOS), interleukin (IL)-1ß, and IL-17 in the rabbit middle ear mucosa after direct gastric content exposure. METHODS: Exploratory controlled study in which histological and immunochemical features were studied after gastric content-induced inflammation was established in rabbits. Sixteen healthy rabbits were divided into two equal groups. Gastric contents of an animal were injected into the middle ear of the same animal for 20 days. Saline was injected into the middle ear of the animals in the control group. The rabbits were humanely killed on day 27. Inflammation was assayed by light microscopy. Immunochemical staining was performed for VEGF, iNOS, eNOS, IL-1ß, and IL-17 expression. Experimental and control animals were examined using the same protocol. RESULTS: The expression levels of VEGF, iNOS, IL-1ß, and IL-17 differed significantly between the experimental and control groups (p=0.018, p=0.010, p=0.002, and p=0.002, respectively). The expression level of eNOS was not significantly different between the two groups (p=0.132). CONCLUSION: This study demonstrates that gastroesophagial reflux induced middle ear inflammation is associated with increased expression of VEGF, IL-1ß, IL-17, and iNOS.

The necessity of dissection of level IIb in laryngeal squamous cell carcinoma: a clinical study.

OBJECTIVE: Head and neck squamous cell carcinomas readily metastasize to adjacent cervical lymph nodes. This is seen frequently in laryngeal squamous cell carcinoma (LSCC), and neck dissection may be performed in addition to excision of the primary lesion. The aim of this study was to define the frequency of level IIb metastasis to the lymph nodes in patients who underwent selective neck dissection because of LSCC. STUDY DESIGN AND SETTING: Cross-sectional study with planned data collection in a tertiary referral hospital. SUBJECTS AND METHODS: Eighty-one patients diagnosed with LSCC were accepted into the study. One hundred forty-eight neck dissection specimens were examined histopathologically, and those with level IIb metastasis were identified. The frequency of level IIb metastasis was evaluated in accordance with the primary tumor site, clinical N stage, central tumor presence, and T stage. RESULTS: Forty-seven of 81 patients were clinically N-, and 34 patients were clinically N+. Level IIb metastasis was seen in 5 (6%) of 81 patients, representing 5 of 148 neck dissection specimens. Two of these 5 patients were clinically N+ (6%), and 3 were clinically N- (6%). The relationship between level IIb metastasis and clinical N stage was not statistically significant (P ≥ .05). Likewise, no statistically significant relationships between the other parameters and level IIb involvement were found. CONCLUSION: Level IIb nodal involvement is very rare in LSCC. Therefore, the area can generally be preserved in elective neck dissection to lessen morbidity and, specifically, to avoid damaging the function of the spinal accessory nerve.

New technique for the treatment of bilateral vocal cord paralysis: Vocal and ventricular fold lateralization using crossing sutures with thyroplasty technique.

CONCLUSION: All patients treated with this new lateralization technique had a good quality of life and no dyspnea at rest or upon exertion. We believe that this technique is an important addition to the many surgical techniques for the treatment of bilateral vocal cord paralysis (BVCP). OBJECTIVES: Most techniques used in the treatment of BVCP result in a prolapse of the laryngeal soft tissues into the endolarynx owing to Bernoulli's principle. We have developed a new lateralization technique to more effectively prevent this prolapse. METHODS: The lateralization was initially tested on six cadaver larynges before being performed in five clinical cases with BVCP, who suffered from dyspnea at rest. Average follow-up was 17.6 months. As in type 1 thyroplasty, a rectangular piece of cartilage was excised horizontally from the thyroid lamina and placed on the defect in the vertical plane. Then, the vocal and ventricular folds were lateralized with crossing sutures, particularly in the posterior region. RESULTS: Dyspnea was eliminated postoperatively. All patients were successfully decannulated. Postoperative voice quality was socially acceptable. Airways were improved postoperatively, as evaluated via fiberoptic laryngoscopy and CT. The mean preoperative and postoperative rima openings were 1.3 mm (range 0.5-2.6) and 6.4 mm (range 3.4-8.1), respectively.

Tympanosclerosis and our surgical results.

Tympanosclerosis is a sequel of chronic otitis media characterized by the deposition of calcareous plaques following hyaline degeneration in the fibrous layer of the tympanic membrane and inside middle ear mucosa. It usually results from prior middle ear infections. In this study, results of treatment and clinical findings of the patients with tympanosclerosis are presented. Our objective is to determine the changes in middle ear caused by tympanosclerosis and intervene in the more problematic zone and find out the more useful treatment protocol for patients. Preoperative features, middle ear findings detected during surgery and postoperative hearing levels of the patients who were operated in our clinic between January 1996 and June 2006 due to tympanosclerosis were evaluated. Surgical treatment was performed on a total of 37 patients including 25 females and 12 males between ages of 11 and 71. Preoperative tympanic membranes perforations were presented at a rate of 91% and average airway bone gap was 37.8 dB. Bilateral involvement was present in 59%. Conductive-type hearing loss was present at a rate of 81%, whereas mixed-type hearing existed at a rate of 19%. Sclerotic plaques were most commonly localized in the attic with a rate of 72%. Post-op outcome was found to be 27% in the patients with air bone gap between 0-20 dB. The best hearing result belonged to type 1 patients. Cases in which stapes footplate was fixated had the worst result in terms of hearing. Teflon piston was only applied in one patient. Our tympanoplasty success was found to be 67%. The most common treatment method of tympanosclerosis is surgery. Stapedectomy is recommended in surgery instead of mobilization techniques. However, there is often recurrence and there is no curative treatment. Therefore rehabilitation with hearing device can be preferred as an adjunct. In the recent experimental studies, good results with topical or systemic agents have also been promising.

[Stomal recurrence after total laryngectomy: clinical and patological analysis of risk factors]. / Total larenjektomi sonrasi stomal nüks: Risk faktörlerinin klinik ve patolojik analizi.

OBJECTIVES: The aim of this study is to evaluate risk factors for stomal recurrence and to state and emphasize the importance of these factors. PATIENTS AND METHODS: This study was carried out retrospectively on 119 patients (116 males, 3 females; mean age 56.8 years; range 31 to 86 years) with larynx cancer who underwent total laryngectomy. All patients were examined for T-stage and location of primary tumor, tracheotomy (preoperative or postoperative) opening time, modality of applied treatment, presence of pharyngeal stoma fistula and presence of cervical lymph node metastasis in the postoperative period. RESULTS: Five patients (4.2%) out of 119 had stomal recurrence. Development period of stomal recurrence after laryngectomy was found to be between six months and three years (mean: 16.6 months). CONCLUSION: The treatment of this fatal complication is very difficult, and it has a poor prognostic nature. As a result, presence of subglottic involvement and advanced tumors in our cases are considered as main risk factors.