Facial canal dehiscence in patients undergoing surgery for chronic otitis media: analysis of 850 patients.

ntroductionIn all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial nerve will be increased in presence of facial canal dehiscence (FCD).AimIn this study, we aimed to evaluate the FCD and its associated situations in patients with chronic otitis media undergoing mastoidectomy.Materials and Methods850 patients who performed ear surgery were reviewed. Patients who did not perform mastoidectomy were excluded. In patients, the ratios, localization of FCD, and association of facial canal dehiscence with cholesteatoma were researched. Association between FCD and closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and radical mastoidectomy procedures, and also an association between FCD and primary or revision surgery was evaluated. ResultsFacial canal dehiscence was found in 8.4% of patients. The relationship between dehiscence and cholesteatoma was found significant (p<0.001). In the comparison of radical mastoidectomy and closed-cavity tympanomastoidectomy, dehiscence was higher in the radical mastoidectomy group (p<0.03). In revision cases, dehiscence was seen more frequently (p<0.003). FCD incidence was higher in adult patients than in pediatric patients (p<0.001). Twenty of 468 patients who were operated on for cholesteatoma had congenital cholesteatoma. ConclusionFacial canal dehiscence can be seen especially in cases with cholesteatoma and when performing radical mastoidectomy and revision surgeries. Therefore, a detailed evaluation of the status of facial nerve and determination of situations in which occurrence of FCD is more likely both preoperatively and intraoperatively will minimalize potential complications.Keywords: Cholesteatoma, tympanic, radical mastoidectomy, oval window, tympanomastoidectomy.

The Effects of Exposure to Environmental Cigarette Smoke on the Vocal Folds of Rats.

OBJECTIVE: This study aimed to investigate histopathologically and immunohistochemically the effects of environmental smoke on the vocal folds. METHODS: This study examined 20 healthy Wistar albino rats, which were divided into four groups of five rats. Group 1 was exposed to smoke for 45 days and group 2 for 90 days. Groups 3 and 4 were the respective control groups. The rats in groups 1 and 3 were sacrificed on day 45 and those in groups 2 and 4 on day 90. The larynx specimens were stained with hematoxylin and eosin, and the inflammation, hyperplasia, and metaplasia were evaluated. Ki-67 staining was used for the immunohistochemical analysis. RESULTS: There was no significant difference in mononuclear cell infiltration between the experimental and control groups (group 1 vs. group 3 P = 0.20, group 2 and 4 P = 0.41) (Table 3), but there was a significant difference between the two experimental groups (P = 0.007). Mild and moderate hyperplasia was seen in groups 1 and 2, respectively. CONCLUSION: Environmental exposure to cigarette smoke has destructive effects on the vocal folds of rats.

Effects of intratympanic dexamethasone on noise-induced hearing loss: An experimental study.

AIM: Aim of the study was to evaluate the effect of intratympanic steroid treatment on hearing based on oto-acoustic emission. METHODS: A total of 16 healthy female Wistar albino rats weighing were used in this study. They were divided in to 2 groups and each group was exposed to noise at 110dB for 25min to induce acoustic trauma. Intratympanic dexamethasone was administered to the middle ears of animals in the experimental group on the same day as exposure to noise. The control group was given 0.09% saline solution. Distortion product otoacoustic emission measurements were performed on days 7 and 10. RESULTS: There were no differences between the emission results of two groups before treatment at 4004, 4761, 5652, 6726, and 7996Hz. There were significant group differences on measurement days 7 and 10 at all frequencies. CONCLUSION: Our study revealed a significant difference in DPOAE measurements on days 7 and 10 between the experimental and control groups. We detected a positive effect of dexamethasone on noise-induced hearing loss.

Analysis of vocal and swallowing functions after horizontal glottectomy.

We conducted a cross-sectional study to assess vocal and swallowing functions after horizontal glottectomy. Our study population was made up of 22 men aged 45 to 72 years (mean: 58.3) who underwent horizontal glottectomy and completed at least 1 year of follow-up. To compare postoperative results, 20 similarly aged men were included as a control group; all glottectomy patients and all controls were smokers. We used three methods-acoustic and aerodynamic voice analyses, the GRBAS (grade, roughness, breathiness, asthenicity, and strain) scale, and the voice handicap index-30 (VHI-30)-to assess vocal function objectively, perceptually, and subjectively, respectively. We also assessed swallowing function objectively by fiberoptic endoscopic evaluation of swallowing (FEES) and subjectively with the M.D. Anderson dysphagia inventory (MDADI). The 22 patients were also subcategorized into three groups according to the extent of their arytenoid cartilage resection, and their outcomes were compared. Acoustic and aerodynamic analyses showed that the mean maximum phonation time was significantly shorter and the fundamental frequency was significantly lower in the glottectomy group than in the controls (p = 0.001 for both), and that the mean jitter and shimmer values and the mean harmonics-to-noise ratio were all significantly higher (p = 0.001 for all); there were no significant differences among the three arytenoid subgroups. Self-assessments revealed that there were no statistically significant differences among the three subgroups in GRBAS scale scores except for the breathiness score (p = 0.045), which was lower in the arytenoid preservation subgroup than in the total resection subgroup; there were no statistically significant differences among the three subgroups in VHI-30 scores. Finally, swallow testing found no statistically significant differences in FEES scores or MDADI scores. We conclude that horizontal glottectomy caused a deterioration in vocal function, but swallowing function was satisfactory.

Evaluation of voice quality after supraglottic laryngectomy.

OBJECTIVE: Supraglottic laryngectomy is a surgical procedure that preserves laryngeal functions. This technique allows extensions including removal of tongue base or 1 arytenoid. We aimed to compare vocal results of supraglottic laryngectomy and extended procedures. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care hospital. SUBJECTS AND METHODS: Thirty-three males who underwent supraglottic laryngectomy were included in the study. Fifteen patients (45.5%) were applied standard supraglottic laryngectomy (standard supraglottic laryngectomy group). In 11 patients (33.3%), unilateral arytenoid cartilage was totally resected by separation at the cricoarytenoid joint (laterally extended group), and the tongue base was removed in 7 patients (anteriorly extended group) (21.2%). Twenty male smokers constituted control group. Acoustic and aerodynamic voice analyses were performed for the assessment of objective results. Grade, roughness, breathiness, asthenia, and strain scale (GRBAS) scores were analyzed for perceptual assessment. Voice Handicap Index-30 was used to evaluate subjective results. RESULTS: The comparison of supraglottic laryngectomy group with the control group revealed that the mean maximum phonation time and fundamental frequency were significantly lower in the supraglottic laryngectomy group (P < .001), and the mean jitter, shimmer, and noise-to-harmonics ratio were significantly higher in the supraglottic laryngectomy group (P < .001). Maximum phonation time and fundamental frequency were higher in the standard supraglottic laryngectomy group in comparison to extended groups. Jitter value was also lower in the standard supraglottic laryngectomy group compared to extended groups. Perceptual and subjective analyses revealed no difference among standard supraglottic laryngectomy and extended groups. CONCLUSION: The results of this study indicate that supraglottic laryngectomy patients have acceptable voice quality, as determined by perceptual and subjective assessment.

Metastatic renal cell carcinoma in the nasopharynx.

Metastatic renal cell carcinoma of the nasopharynx, nasal cavity, and paranasal sinuses can be misdiagnosed as primary malignant or benign diseases. A 33-year-old male attended our outpatient clinic complaining of difficulty breathing through the nose, bloody nasal discharge, postnasal drop, snoring, and discharge of phlegm. Endoscopic nasopharyngeal examination showed a vascularized nasopharyngeal mass. Under general anesthesia, multiple punch biopsies were taken from the nasopharynx. Pathologically, the tumor cells had clear cytoplasm and were arranged in a trabecular pattern lined by a layer of endothelial cells. After the initial pathological examination, the pathologist requested more information about the patient's clinical status. A careful history revealed that the patient had undergone left a nephrectomy for a kidney mass diagnosed as renal cell carcinoma 3 years earlier. Subsequently, nasopharyngeal metastatic renal cell carcinoma was diagnosed by immunohistochemical staining with CD10 and vimentin. Radiotherapy was recommended for treatment.

Efficacy of systemic steroid treatment in sinonasal polyposis.

AIM: Nasal polyposis is an inflammatory disease of unknown origin. Systemic steroid treatment is effective not only in decreasing polyp size but also in controlling mucosal inflammation. We evaluated the efficacy of mean-term systemic corticosteroid treatment in nasal polyposis clinically and radiologically. METHODS: Seventy-five patients with nasal polyposis were included in this study. Patients were treated with methylprednisolone for 20 days. Clinical response was evaluated by nasal symptom scores and changes in polyp size; disease extent was assessed by paranasal sinus tomography. Nasal symptom score, polyp size, and disease extent were reevaluated after therapy. RESULTS: Twenty-one (28%) of 75 patients were female, and 54 (72%) were male. The mean age was 41.63 ± 11.04 with a range of 17 to 80 years. As shown radiologically, 26.7% (n = 20) of patients completely healed, and 41.3% (n = 31) partially healed, whereas there was no improvement in 32% (n = 24). There was a statistically significant improvement in radiological assessment (P < 0.01). The sense of smell showed the greatest improvement (56.98%). The least-improved symptoms were facial pain and headache (37.74%). There was a statistically significant decrease in polyp grade (P < 0.01). CONCLUSIONS: Systemic steroid treatment caused a decrease in all nasal symptoms and polyp size and improved paranasal computed tomography results. In addition, it shortened the duration of surgery and improved the quality of the procedure. Systemic steroid treatment also contributed to the prevention of recurrence.

Protective effect of pentoxifylline on amikacin-induced ototoxicity in rats.

PURPOSE: This experimental study was performed to investigate the possible protective effect of pentoxifylline (PTX) on amikacin-induced ototoxicity in rats. MATERIALS AND METHODS: In this study, 21 healthy female rats were randomly assigned to 1 of 3 groups: the amikacin group (n = 8), the amikacin + PTX group (n = 8), and the control group (n = 5). The amikacin group received amikacin (200 mg·kg(-1)·day(-1)) intramuscularly once daily for 14 days. The amikacin + PTX group received intramuscular injections of amikacin (200 mg·kg(-1)·day(-1)) once daily for 14 days and PTX (25 mg·kg(-1)·day(-1)) once daily via gastric gavage for 14 days. The control group received saline solution (1 mL·day(-1) intraperitoneal injections) once daily for 14 days. The hearing levels of the rats were evaluated using distortion product otoacoustic emissions before and after treatment. RESULTS: The distortion product otoacoustic emissions' amplitude levels (decibel, sound pressure levels) measured before and after treatment at frequencies of 4000, 6000, and 8000 Hz revealed that values of the amikacin group dropped significantly at the end of treatment (P < .01). In contrast, the amikacin + PTX and the control groups showed no significant difference at the end of the treatment compared with the initial measurements (P > .05). CONCLUSION: The results showed that PTX has protective effects on hearing functions in amikacin-induced ototoxicity in rats.

Multidimensional evaluation of vocal function after supracricoid laryngectomy with cricohyoidopexy.

OBJECTIVES: The aim of this study was to assess the vocal outcome and the impact of arytenoid resection on vocal function following supracricoid laryngectomy with cricohyoidopexy. METHODS: Twenty-eight male patients who had undergone supracricoid laryngectomy with cricohyoidopexy were included in the study. In 7 patients, one arytenoid cartilage had been totally resected; in 11, both arytenoid cartilages had been preserved; and in 10, one arytenoid cartilage had been partially resected. The maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were assessed and analyzed. Perceptual analysis was performed with the grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Abduction-adduction and anteroposterior squeezing actions were analyzed from videoendoscopic records. The Voice Handicap Index-10 (VHI-10) was used for self-assessment. RESULTS: The acoustic and aerodynamic parameters and GRBAS score showed severe impairment. The self-assessment revealed that patients were relatively satisfied with their voice quality. There were no statistically significant differences in the acoustic and aerodynamic parameters, the GRBAS score, or the VHI-10 score according to the level of arytenoid resection. CONCLUSIONS: Supracricoid laryngectomy with cricohyoidopexy caused deterioration of acoustic and aerodynamic voice parameters and the GRBAS score. Statistically, the level of arytenoid resection had no apparent effect on the objective, perceptual, or subjective voice parameters.

Analysis of swallowing function after supracricoid laryngectomy with cricohyoidopexy.

OBJECTIVE: To evaluate the swallowing function after supracricoid laryngectomy with cricohyoidopexy, focusing on the effects of arytenoid cartilage resection and radiation therapy. STUDY DESIGN: Case series with chart review. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Thirty supracricoid laryngectomy-cricohyoidopexy patients, at least 1 year after treatment, were retrospectively analyzed. Fiber-optic endoscopic evaluation of swallowing was performed for each patient. Three blinded judges evaluated the video recordings based on 3 parameters. The M. D. Anderson Dysphagia Inventory was completed by each patient for assessment of disease-specific quality of life. RESULTS: All patients were decannulated at an average of 23.6 days. Nasogastric feeding tubes were removed at an average of 27.3 days, and all patients could eat orally. Fiber-optic endoscopic evaluation of swallowing showed that patients with total resection of 1 arytenoid had more bolus retention than patients with both arytenoids preserved (P = .008). Compared with patients who did not receive radiotherapy, patients who did receive radiotherapy exhibited increased retention (P = .021) and aspiration (P = .007). The M. D. Anderson Dysphagia Inventory results revealed no differences in quality of life according to the level of arytenoid resection or the administration of radiotherapy. CONCLUSION: The functional evaluation of swallowing after supracricoid laryngectomy-cricohyoidopexy showed satisfactory results. Patients with total resection of 1 arytenoid had significantly higher bolus retention, and those who received radiotherapy had significantly increased retention and aspiration.

Supracricoid laryngectomy with cricohyoidopexy: oncological results.

This study assessed the oncological results in patients undergoing supracricoid laryngectomy with cricohyoidopexy. A cohort of 44 patients surgically treated using supracricoid laryngectomy with cricohyoidopexy between June 2001 and December 2009 was retrospectively analyzed. The mean follow-up period was 53.2 (±24.7) months. The Kaplan-Meier method was used to analyze overall survival and disease-specific survival, as well as survival according to T2 and T3 subgroups. Overall survival rates at 3 and 5 years were 90.5 and 84.1%, respectively. The 3- and 5-year disease-specific survival rates were 95.4 and 92.5%, respectively. Overall survival for patients with T2 disease was 87.5% at 3 years and 80.8% at 5 years. For T3, the corresponding rates were 91.8 and 87.0%. Disease-specific survival for patients with T2 disease was 93.3% at 3 years and the same at 5 years; the corresponding rates for T3 were 96.4 and 91.4%. The differences between T2 and T3 patients at 3 and 5 years with respect to overall and disease-specific survival were not statistically significant (P = 0.903 and P = 0.863, respectively). Recurrence was local in one patient (2.2%) and regional in three (6.8%). There were three distant metastases (6.8%) and one second primary carcinoma (2.2%). These findings support the use of supracricoid laryngectomy with cricohyoidopexy as an oncologically safe technique in properly selected patients with laryngeal carcinoma.

[The healing effects of vitamin E with corticosteroid and vitamin E alone on nerve healing in rats with traumatic facial palsy]. / Travmatik fasyal paralizili siçanlarin sinir iyilesmesinde E vitaminiyle beraber kortikosteroid ve tek basina E vitamini uygulanmasinin etkileri.

OBJECTIVES: We aimed to document the effects of vitamin E and vitamin E plus corticosteroid on nerve healing in rats. MATERIALS AND METHODS: Twenty-four Wistar Albino type female rats were used in the study. The rats were divided in to three groups, each with eight rats. Group 1 was given methylprednisolone and Vitamin E, group 2 was given Vitamin E alone and group 3 was the control group. The buccal branch of the facial nerve was found under anesthesia in all rats. After nerve identification, the stimulation thresholds were assessed by Xomed Trace Nerve Integrity Monitor NIM-2. The buccal branch of each facial nerve in group 1 and 2 was traumatized by a vascular clamp for an hour. After trauma the stimulus thresholds were identified again. The nerve was not traumatized in group 3. Group 1 was given 0.1 mg/kg/day vitamin E intramuscular (i.m) and 1 mg/kg/day methylprednisolone i.m for one month, group 2 was given 0.1 mg/kg/day vitamin E i.m for one month and the control group was given 2 cc 0.09% NaCl subcutaneously every other day for one month. At the end of a month the stimulus thresholds were measured again and compared statistically. RESULTS: Mean stimulus threshold was 0.12 mA for all of the groups at the beginning of the experiment. After trauma mean stimulus threshold was 0.48 mA for the group 1 and 2. At the end of one month stimulus threshold was 0.22 mA for the group 1 and 0.33 mA for the group 2. The stimulus threshold in the control group was measured as 0.12 mA. CONCLUSION: We concluded that the vitamin E has a positive effect on nerve healing and corticosteroid enhances its effect.

[Voice quality assessment via acoustic and spectrographic analysis in patients who had endolaryngeal microsurgery]. / Endolarengeal mikrocerrahi uygulanan hastalarda ses kalitesinin akustik ve spektrografik analiz ile degerlendirilmesi.

OBJECTIVES: In this study, changes in quality of voice in patients who underwent endolaryngeal microsurgery were assessed by objective voice analyses. PATIENTS AND METHODS: Thirty patients (17 females, 13 males; mean age 34.3+/-11.5 years; range 17 to 65 years), who underwent endolaryngeal microsurgery because of benign vocal cord pathology and 25 people (12 females, 13 males; mean age 28.7+/-6.6 years; range 22 to 50 years), without laryngeal pathology were included in this study. Voice records, which were taken from the patients pre- and postoperatively, and also from the control group, were analyzed acoustically and spectrographically. Cool-Edit software was used for voice recording, and Praat software was used for voice analysis. Parameters, which were obtained in the study, were compared statistically. RESULTS: When pre- and postoperative acoustic analysis results were compared, it was found out that there was significant difference in all parameters except fundamental frequency. While S/Z ratio, and jitter and shimmer values were significantly decreased postoperatively, maximum phonation time, harmonic/noise ratio, and intensity values were significantly increased. No important changes were detected in fundamental frequency value. Postoperative and control group findings were not significantly different. At long term average spectrum analysis of the phonetically balanced read passage records, postoperative amplitude value was increased significantly, compared to preoperative values. CONCLUSION: Acoustic and spectrographic voice analyses are objective methods which can be used to assess effects of endolaryngeal microsurgery on quality of voice.

[Asymptomatic salivary gland stone of unusual size in the Wharton's duct]. / Wharton kanalinda semptom vermeyen dev tükürük bezi tasi.

A 44-year-old male patient presented with a complaint of dysphonia. On oropharynx examination, a polypoid mass was detected in the right vocal cord and firmness in the floor of the mouth, 3-4 cm in size. Computed tomography showed a stone in the right Wharton's duct. Saliva came out of the orifice of the Wharton's duct on palpation. The stone was removed transorally. Despite its huge size (30x20 mm), the patient had no complaint. No recurrence was seen during a follow-up period of 18 months with ultrasonography.

Two cases of nasal natural killer T-cell lymphoma.

Nasal natural killer T-cell lymphoma is a very aggressive and destructive disease with a poor prognosis. We hereby present two male patients in whom diagnostic problems and a mortal course were encountered. One patient (age 31 years) had progressive ulceration in the nasal area. Two biopsies that had been taken elsewhere were inconclusive. The other patient (age 40 years) was referred with a previous histopathologic diagnosis of squamous cell carcinoma. He complained of an unhealing wound in the hard palate. Biopsies were repeated in each case. Diagnosis was made by immunohistochemical examination. Both patients died shortly after the diagnosis. The importance of obtaining an adequate and deep biopsy sample and employing sophisticated immunohistochemical examination is emphasized for an accurate diagnosis.

[Comparison of magnetic resonance imaging findings with postoperative histopathologic results in laryngeal cancers]. / Larenks kanserlerinde manyetik rezonans görüntüleme bulgularinin ameliyat sonrasi histopatolojik sonuçlarla karsilastirilmasi.

OBJECTIVES: We compared the findings of magnetic resonance imaging (MRI) with histopathologic results in laryngeal cancer. PATIENTS AND METHODS: Twenty-five patients (24 males, 1 female; mean age 58 years; range 24 to 80 years) were evaluated preoperatively by MRI with regard to involvement of the thyroid cartilage, anterior commissure, vocal cords, sinus pyriformis, subglottic region, and prelaryngeal soft tissues. The findings were compared with those of histopathologic examination. RESULTS: The highest accuracy was found in the detection of invasion to the prelaryngeal soft tissue (92%). The accuracy of MRI was 84% for the anterior commissure, 80% for vocal cords, 76% for the thyroid cartilage, and 72% for sinus pyriformis and the subglottic region. CONCLUSION: Magnetic resonance imaging proved to be useful in the preoperative evaluation of laryngeal cancers.