Effects of polycystic ovary syndrome and menopause on rat soft palate and base of tongue.

OBJECTIVE: To investigate the histopathologic changes in rat soft palate and base of tongue by performing experimental polycystic ovary syndrome (PCOS) and menopause models. STUDY DESIGN: Experimental study. SETTING: The study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. SUBJECT AND METHODS: Thirty healthy female Albino Wistar rats were divided into 4 groups (PCOS study group [n = 10], per oral letrozole given; PCOS control group [n = 6], per oral saline given; menopause study group [n = 8], ovariectomized; menopause control group [n = 6], sham operated). At the end of the follow-up periods, all animals were euthanized, and soft palates and base of tongues of all groups were removed to observe the histopathologic changes. RESULTS: When we compared the PCOS study group with the PCOS control group, submucous gland hypertrophy, mast cell infiltration, vascular engorgement, and acanthosis were significantly different in the soft palate (P < .05), and in addition to these findings, lymphocyte infiltration, subepithelial edema, and dilated glandular excretory duct were significantly different in base of tongue (P < .05). When we compared the menopause study group with the menopause control group, only vascular engorgement was significantly different in the soft palate (P < .05), and in addition to this finding, submucous gland hypertrophy, lymphocyte infiltration, polymorphonuclear leukocyte infiltration, and subepithelial edema were significantly different in base of tongue (P < .05). CONCLUSION: Our findings suggest that PCOS and menopause induce significant histopathologic changes in the soft palate and base of tongue that are similar to the histopathologic changes seen in the soft palate and base of tongue of patients with obstructive sleep apnea syndrome.

Adult tonsillectomy: relationship between indications and postoperative hemorrhage.

OBJECTIVES: In this study, we aimed to determine the possible relationship between the indications for tonsillectomy in adult population and to estimate the incidence of postoperative hemorrhage. PATIENTS AND METHODS: Medical records of 200 adult patients who underwent tonsillectomy between January 2003 and October 2008 were retrospectively analyzed. RESULTS: The indications for adult tonsillectomy were chronic infection in 153 patients (76.5%); upper airway obstruction secondary to tonsillar hypertrophy in 37 patients (18.5%) and suspected neoplasms in 10 patients (5%). Sixteen patients (8%) had postoperative hemorrhage. Fourteen patients of 153 patients (9.2%) who underwent surgery with the indication of chronic infection and two of 37 patients (5.4%) who underwent surgery with the indication of upper airway obstruction secondary to tonsillar hypertrophy had also postoperative hemorrhage. None of the 10 patients who operated with the indication of suspected neoplasm had postoperative hemorrhage. Although the incidence of postoperative hemorrhage according to the indications of adult tonsillectomy in descending order was chronic infection (9.2%), upper airway obstruction secondary to tonsillar hypertrophy (5.4%) and suspected neoplasms (0%), it was found that the incidence of postoperative hemorrhage was not statistically significantly related to the indications for tonsillectomy. CONCLUSION: The incidence of postoperative hemorrhage was not statistically significantly related to the indications for tonsillectomy. In addition, we believe that surgery is a more common cause of postoperative hemorrhage rather than chronic infections.

Audiological and graft take results of cartilage reinforcement tympanoplasty (a new technique) versus fascia.

Our objective is to compare hearing and graft take results of temporal muscle fascia tympanoplasty and cartilage reinforcement tympanoplasty. Seventy seven patients are classified into two groups: Group 1 included 37 patients for whom cartilage graft, harvested from symba concha, is used as reinforcement under temporalis muscle fascia anteriorly and Group 2 included 40 patients for whom only temporalis muscle fascia is used in type 1 tympanoplasty. A pure-tone audiometry is done within 1 week prior to surgery and at 6 months postoperatively. There is statistically significant difference between postoperative graft take results among groups. In both groups postoperative anterior TM perforation is encountered most commonly. Success rate of cartilage reinforcement tympanoplasty in revision patients is 100% but temporal muscle fascia tympanoplasty's is 66%. There is no statistically significant difference between preoperative and postoperative air conduction gain of TM intact patients. The results indicated that Cartilage reinforcement myringoplasty technique under anterior of the temporal muscle fascia significantly increases the graft take ratios in high-risk perforations and it also does not affect hearing levels. Therefore, the authors suggest usage of cartilage reinforcement tympanoplasty technique under anterior of the temporal muscle fascia which is an easy and applicable technique to increase graft take ratios, particularly in patients with preoperative anterior and subtotal TM perforations.

Do the laryngopharyngeal symptoms and signs ameliorate by empiric treatment in patients with suspected laryngopharyngeal reflux?

OBJECTIVES: In clinical practice, antireflux medication is given almost always empirically without pH monitorization. We aimed to evaluate the improving effect of empiric antireflux treatment on layngopharyngeal symptoms and signs in patients with gastroesophageal reflux (GER) and suspected laryngopharyngeal reflux (LPR) according to reflux symptom index (RSI) and reflux finding score (RFS). METHODS: GER was determined by esophagogastroduedonoscopy and biopsy in 127 patients. RSI and RFS were calculated for each patient. The patients with a pathology other than LFR which may be responsible from laryngopharyngeal symptoms and signs were excluded from the study. Fifty patients whom were thought to have LPR according to RSI and RFS comprised the study group. After 12-weeks of antireflux treatment, RSI and RFS were calculated again. The statistical analyses were made according to the changes in the severity and frequency of each symptom and sign. RESULTS: There was statistically significant improvement in RSI and RFS after treatment when compared with initial scores. There was statistically significant improvement in severity of all symptoms and signs. Although there was quantitively decrease in frequency of some signs and symptoms, complete resolution of the disease was not observed generally. CONCLUSION: Empiric antireflux treatment according to RSI and RFS is an effective method. Antireflux treatment has a significant improving effect on laryngopharyngeal symptoms and signs. There may be needed longer times of treatment for complete resolution of symptoms and signs.

Does reflux have an effect on nasal mucociliary transport?

CONCLUSION: Gastroesophageal and laryngopharyngeal reflux were found to have no effect on nasal mucociliary transport. OBJECTIVE: Gastroesophageal and laryngopharyngeal reflux have been recognized as causative factors for chronic rhinosinusitis but no definite mechanism has been described yet. We aimed to determine whether gastroesophageal and laryngopharyngeal reflux impair nasal mucociliary transport. METHODS: This was a prospective cohort study in a tertiary referral center. Fifty patients with both laryngopharyngeal and gastroesophageal reflux comprised the study group. Reflux syndrome index and reflux finding score were calculated for each patient before and after treatment. Antireflux medication was given for 12 weeks. The control group consisted of 30 healthy volunteers. Nasal mucociliary transport was assessed by means of the saccharine test. It was performed before and after the treatment. Statistical analysis was performed using the saccharine test results of the study and control groups. RESULTS: No statistical difference was found between the saccharine test results of the study group and control group before treatment. The differences between the pretreatment and post-treatment reflux symptom index and reflux finding scores were statistically significant. The difference between the post-treatment saccharine test results of the patients in whom reflux scores returned to normal and those with remaining high scores was not statistically significant.

Cartilage reinforcement tympanoplasty: otological and audiological results.

CONCLUSION: High risk perforations including total, subtotal, atelectatic perforations, those with cholesteatoma and revision cases can be treated efficiently with cartilage reinforcement tympanoplasty. OBJECTIVE: The purpose of this study was to describe the perforation closure rates and hearing results of cartilage reinforcement tympanoplasty. METHODS: This was a retrospective chart review and included 60 patients who underwent surgery with the cartilage reinforcement technique between November 2006 and October 2008 at the Department of Otorhinolaryngology of Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey. The male to female ratio was 28 (46.7%)/32 (53.3%). The mean age of the patients was 30.10 +/- 11.50 years (range 13-55). RESULTS: Preoperatively, only one patient had a retraction pocket but not a perforation, 12 (20%) patients had perforation of < 25% of the total tympanic membrane diameter, 12 patients had perforation between 25% and 50% of the total membrane diameter, 18 patients had a perforation between 50% and 75% of total membrane diameter and 17 patients had a perforation of > 75% of the total membrane diameter. Postoperatively we achieved total closure of tympanic membrane perforations for 47 patients but the perforations of 13 patients remained in various sizes (7 patients had tympanic membrane perforation < 25% of the total membrane diameter, 3 between 25% and 50%, 2 between 50% and 75% and 1 patient had a perforation > 75% of the total membrane diameter). There was a statistically significant difference between percentages of preoperative perforation and postoperative perforations (p = 0.001). Only 1.7% of patients had no perforation preoperatively and this ratio increased to 78.3% postoperatively. Also, 30% of patients had a perforation between 50% and 75% of the total membrane diameter, 28.3% of the patients had a perforation > 75% of the total membrane diameter preoperatively and this ratio decreased to 3.3% and 1.7%, respectively. Concerning the audiological parameters, the difference between preoperative and postoperative hearing levels was statistically significant (p = 0.001).

Determination of optimum dosage of intraoperative single dose dexamethasone in pediatric tonsillectomy and adenotonsillectomy.

OBJECTIVE: Our objective is to determine the optimum dosage of intraoperative single dose dexamethasone and its effect upon postoperative morbidity in pediatric tonsillectomy and adenotonsillectomy patients. STUDY DESIGN AND METHODS: Totally 150 pediatric patients whom underwent adenotonsillectomy or tonsillectomy surgery are offered to participate in this study at otorhinolaryngology clinic between 2002 and 2003. 150 patients are divided into three randomized groups, each composed of fifty patients. Anesthesia protocol is standardized in each group and 0.2 mg/kg intraoperative dexamethasone is given to first group, 0.7 mg/kg (maximum dose 25 mg) intraoperative dexamethasone is given to second group and third group is accepted as control group without giving any intravenous dexamethasone. Each group is compared for postoperative nausea, vomiting and tolerability to take oral foods within first 24h with the same questionnaire. RESULTS: There is significantly higher ratio of postoperative nausea and vomiting within first 24h in group III (80%) when compared with group I (8%) (p: 0.001; p<0.01) and group II (4%) (p: 0.001; p<0.01). Also there is significantly higher ratio of patient's tolerability to take oral semisolid/solid foods within postoperative first 24h in group II (94%) when compared with group I (58%) (p: 0.001; p<0.01) and group III (12%) (p: 0.001; p<0.01). We didn't encounter any side effect of dexamethasone in group I and II. CONCLUSIONS: We thought that 0.7 mg/kg dosage of IV dexamethasone is much a preferable choice depending of its effectiveness on decreasing postoperative morbidity rather than 0.2 mg/kg dosage and beside to this advantage we didn't encounter any side effects.

Deleterious effect of smoking and nasal septal deviation on mucociliary clearance and improvement after septoplasty.

OBJECTIVES: To investigate the effect of septal deviation, septoplasty, and smoking upon nasal mucociliary clearance by using saccharine test. METHODS: Included in this study were 40 patients (15 women and 25 men) who had septal deviation and septoplasty surgery performed between March and June 2006. Patients are classified into three groups: group I (n = 20) nonsmoking patients who had septoplasty surgery, group II (n = 20) smoking patients who had septoplasty surgery, and the control (n = 20) group. None of the control group has nasal breathing problem or smoking history. For determining preoperative and postoperative nasal mucociliary clearance (MCC) time, a saccharine test was performed on the patients 1 day before surgery and at the third month of postoperative control. RESULTS: Preoperative and postoperative nasal MCC time in patients of group I are statistically significantly lower than the group II (p < 0.01). Postoperative MCC time in group I and II is significantly decreased compared with preoperative MCC time, statistically (p < 0.01). Preoperative and postoperative MCC time of group I and group II is significantly higher than MCC time of the control group (p < 0.01). CONCLUSION: Nasal septal deviation and smoking deteriorates nasal MCC time and this result can be shown easily with the saccharine test. Properly performed septoplasty surgery decreases nasal MCC time during the late postoperative period but MCC times are still longer than normal. The saccharine test can be used for following up the effect of septoplasty upon nasal mucosa.

Effect of functional neck dissection and postoperative radiotherapy on the spinal accessory nerve.

CONCLUSIONS: We encountered shoulder syndrome after functional neck dissection (FND) less frequently than reported in the literature. This technique is a favorable treatment choice for appropriately selected patients with head and neck cancer with cervical metastasis. It depends on careful dissection of neurovascular tissues during surgery and preserved shoulder function due to chronic neurological degeneration caused by surgery. Also, radiotherapy has an evident negative effect on the accessory nerve. OBJECTIVES: To perform postoperative electrophysiological tests on the spinal accessory nerve (SAN) after FND and postoperative radiotherapy. SUBJECTS AND METHODS: A study group of 16 patients with head and neck cancer who underwent 22 FNDs and 10 volunteers in the control group were evaluated. The SAN latency and amplitude were measured and then upper trapezius muscle electromyography (EMG) was performed on all the patients and the volunteers. RESULTS: The EMG results of the study group revealed 19 cases with normal findings, 1 with total and 2 with partial axonal degeneration. The amplitude levels of the SAN in the study group showed statistically significant decrease when compared with the control group. The latency levels of the SAN in the four patients who received postoperative radiotherapy were significantly longer than those in cases who did not receive this therapy.

[Pharyngocutaneous fistula after total laryngectomy: incidence, predisposing factors, and treatment]. / Total larenjektomi sonrasi farengokutanöz fistül: Sikligi, etkileyen faktörler ve tedavi yaklasimi.

OBJECTIVES: We investigated the incidence and etiologic factors of pharyngocutaneous fistulas occurring after total laryngectomy. PATIENTS AND METHODS: The study included 53 patients (46 males, 7 females; mean age 59 years; range 34 to 84 years) who underwent total laryngectomy for epidermoid carcinoma. Risk factors for pharyngocutaneous fistula, its incidence and time of occurrence, treatment approaches, and length of hospital stay were evaluated. RESULTS: Pharyngocutaneous fistula developed in 19 patients (35.9%) within a mean of 7.4 days postoperatively. Age, smoking, the presence of chronic systemic disease; T1-T2 stage, localization, and differentiation of tumor, concomitant bilateral neck dissection, T/Y shaped pharyngeal closure, and high fever in the first postoperative 48 hours did not show any significant relationship with the formation of fistula. Factors significantly associated with fistula formation were T4 stage, alcohol consumption, postoperative anemia, and hypoproteinemia. The mean hospital stay was 40.5 days in patients with pharyngocutaneous fistula compared with 15.3 days in patients without fistula. CONCLUSION: Postoperative anemia, hypoproteinemia, alcohol consumption, and T4 stage are significant risk factors for pharyngocutaneous fistula formation.