Effects of Inhaled Fluticasone Propionate on Wound Healing After Surgical Phonotrauma Model in Rabbit Larynx.

OBJECTIVES: The aim of this study was to evaluate the effects of inhaled fluticasone propionate on wound healing after phonosurgical trauma of larynx in rabbit model. STUDY DESIGN: A randomized controlled study on experimental animals (rabbits). METHODS: In this prospective experimental animal study, surgically induced type 2 scar was created under general anesthesia in 52 vocal folds of 26 rabbits. Inhaled fluticasone propionate was administered to 13 rabbits in the treatment group for 5 days after the trauma. Rabbits were sacrificed on the 10th, 30th, and 90th days. Histopathological examinations were performed to evaluate epithelization process, inflammation density, and collagen density at the wound side and the results compared between the groups. RESULTS: On the 10th day after surgical trauma, re-epithelialization was completed in both the treatment and the control groups. There was no difference between the groups in terms of mononuclear cell density on the 10th and 90th days (P > 0.05), but the inflammatory cell density was found to be lower in the treatment group on the 30th day (P = 0.005). Collagen density was significantly lower in all animals treated with inhaled fluticasone propionate, and sacrificed on the 10th, 30th, and 90th days, compared to the control group (P = 0.010, P = 0.038, and P < 0.001, respectively). CONCLUSIONS: Inhaled fluticasone propionate to be applied after phonotrauma reduces inflammation and collagen density in scar tissue in rabbits. Future clinical studies will be promising for the positive effects of inhaled steroids on voice quality after phonosurgery.

Disease and Quality of Life Aspects of Cat Allergy in Non-Pet Owners with Allergic Rhinitis.

INTRODUCTION: The severity of cat allergy-related symptoms varies widely. The rising prevalence of cat owning makes it a significant human health problem. The aim of this study was to evaluate disease severity and quality of life (QoL) aspects of cat sensitization and allergy in non-pet owners with allergic rhinitis (AR). METHODS: In this study, 231 out of 596 patients with AR were enrolled. The disease severity and QoL measures of the non-pet owner patients were evaluated according to their demographics and allergen sensitizations. The data were re-gathered after cat exposure for cat-sensitized patients (n = 53). RESULTS: The median age of the patients (174 females, 57 males) was 33 (18-70). The overall frequency of cat sensitization was 12.6% (75/596). The frequency of cat allergy in this cohort was 13.9% (32/231). Family history of atopy and multi-allergen sensitization were more common in the cat-sensitized patients. Disease severity and QoL scores were higher in the cat allergy group after cat exposure. Cat allergy was the major independent risk factor for the severity of AR and QoL measures. CONCLUSION: Due to the fact that indirect exposure to cat dander allergens can occur anywhere, even where cats are not present, cat-sensitized people should be aware of cat allergy. Cat allergy appears to be an independent risk factor for disease severity and QoL effects for non-pet owner patients with AR.

Successful Treatment of Central Nervous System Involvement in Posttransplant EBV-related Lymphoproliferative Disease With Intrathecal Rituximab Therapy.

The posttransplant lymphoproliferative disease is a severe cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation. Central Nervous System involvement in EBV-related PTLD is rare, and there is no standard treatment recommendation. We present our patient and discuss other previously reported cases of EBV-associated PTLD with CNS involvement.

Comparison of Treatment Outcomes Between Total and Near Total Glossectomy with Larynx Preservation and Flap Reconstruction: A Single Institution Experience with 23 Patients.

Objective: The purpose of this study was to evaluate the functional and oncological outcomes of total glossectomy with laryngeal preservation (TGLP) compared to near-total glossectomy with laryngeal preservation (nTGLP). Methods: In this retrospective study, the data of 23 patients who underwent either TGLP or nTGLP between January 2010 and December 2020 in a tertiary university hospital were analyzed. The data including demographic findings, tumor stage, extent of surgery and technique, method of reconstruction, complications, overall survival (OS) and recurrence-free survival (RFS), and tracheostomy and gastric tube dependence during follow-up were assessed. Results: Of the 23 eligible patients, 15 had undergone nTGLP (Group 1) and 8 had undergone TGLP (Group 2). Tracheostomy dependence and gastric tube dependence rates at the sixth month were 3/19 (15.7%) and 12/19 (63.1%), respectively, with no significant differences between the two groups. OS and RFS at one year were 47.6% and 27.8%, respectively, for the study population. OS rate showed significance with nodal positivity and extranodal extension (p=0.004 for both) only, but not within patient groups (p=0.734). Conclusion: Both TGLP and nTGLP are feasible treatment options in patients with advanced tongue cancer with no differences in terms of functional and oncological results. Survival rates are still not satisfactory, and recurrences are high despite appropriate treatments. Proper selection of patients who are highly motivated and willing for long-term postoperative rehabilitation is essential.

Treatment Results and Postoperative Complications of Single-Stage Tracheal Resection in Adolescent Patients with Post-Intubation Tracheal Stenosis, Compared to Adults.

Objective: The purpose of this study was to analyze the treatment outcomes and postoperative complications of tracheal resection in patients under the age of 19 years with post-intubation tracheal stenosis, and to compare the results with those of adults. Methods: Data were retrospectively retrieved from the medical records, including demographic characteristics, perioperative features, any postoperative complications and follow-up statuses of the patients. Treatment results and postoperative complications were compared between adolescent and adult groups. Results: Overall, anastomotic and non-anastomotic complication rates in the adolescent group and the adult group were 40%, 40%, 10% and 63%, 44.4%, 33.3%, respectively. Overall treatment success rates based on tracheostomy tube and tracheal stent free status were 90% and 92.6% in adolescent and adults, respectively. Conclusion: Treatment success rates and incidence of anastomotic complications were found similar in patients under the age of 19 years and adult patients who underwent single-stage tracheal resection and end to end anastomosis for treatment of post-intubation tracheal stenosis.

Clustering upper airway physicals, otitis media with effusion and auditory functions in children.

OBJECTIVE: Adenoid hypertrophy (AH) has been identified as a cause of otitis media with effusion (OME), which is the most common cause of childhood hearing loss. Indeed, there may be other upper airway-related predisposing factors such as, location of the adenoid, accompanying tonsillar hypertrophy (TH) and nasal septal deviation (NSD) for the development of OME. In this study, we aimed to evaluate the associations between the upper airway physicals and OME with auditory functions. METHODS: Eighty-six ears of 43 children, aged 3-11 years were included in this prospective clinical study. Findings of otolaryngologic examinations were noted. Data of pure tone audiometry (PTA), traditional tympanometry (TT) and wideband tympanometry (WBT) parameters were collected. Cluster analysis was performed to the following variables: age, sex; the adenoid choana percentage (ACP), the presences of adenoid around torus tubarius (AATT), TH, NSD and OME; peak pressure (PP) values on TT, resonance frequencies (RF) on WBT, ambient pressure absorbance ratios (APAR) and PTA hearing thresholds. RESULTS: Two groups of ears revealed by clustering; cluster-1 (n = 46) and cluster-2 (n = 40), at the similarity level of 0.662. The presences of AH, AATT, OME and the medians of ACP, PP, RF, WBT APARs at all frequencies except 5656 Hz and 8000 Hz, all PTA thresholds were significantly different between two clusters (p < 0.05). The lower WBT APARs and higher PTA thresholds were associated with higher levels of ACP and higher frequencies of the presence of AATT and OME in cluster-1. CONCLUSION: There are associations between AH, AATT and OME together with decline in hearing and SEA. Whereas, TH and NSD are not related to the formation of clusters and they are insignificant factors.

The Bibliometric Aspects of Case Report/Series in Science Citation Index Otorhinolaryngology Journals.

OBJECTIVE: The rate of case report/series (CR/S) acceptance by the high impact journals is steadily declining mainly due to low citations. The aim of this study is primarily to investigate the bibliometric aspects of CR/S in the field of otorhinolaryngology (ORL) and secondarily to guide prospective authors as to which type of CR/S have better chances of acceptance and citation in the current publication climate. METHODS: Bibliometric and citation analysis of CR/S published in Science Citation Index (SCI) journals of ORL covering the years of 2012-2016 was conducted. RESULTS: There were 1332 (8.9%) CR/S among 14900 publications in 11 SCI ORL journals published between January 1st, 2012 and December 31st, 2016. The most common published field and subject were the 'pediatric ORL' (33.2%) and 'rare cases/conditions' (47.1%) respectively. 'General ORL' (5.13) and 'treatment' (4.93) categories had the highest citations. Only 10% of CR/S had ≥10 citations. The mean citation counts were positively correlated with impact factors of journals (r=0.131, p<0.001), mean number of authors (r=0.151, p<0.001), mean number of cases (r=0.192, p<0.001), mean number of references (r=0.315, p<0.001) and mean number of Web of Science visits (r=0.291, p<0.001). CONCLUSION: Although CR/S provides low citation rates in ORL SCI journals, they may serve important topics in terms of diagnosis, treatment, or complications. The findings and the main discussions of this study may direct the rationale for the consistent publication of CR/S in the evidence-based medicine era.

The prognostic value of thyroid gland invasion in locally advanced laryngeal cancers.

BACKGROUND: Locally advanced laryngeal cancers can spread to the thyroid gland by direct invasion of cricothyroid membrane. The prevalence of thyroid gland invasion (TGI) and the predictive factors of TGI were well described in literature. However, the association of TGI with survival was undetermined yet. OBJECTIVES: The aim of this study is to analyze the effects of TGI on survival rates in patients with locally advanced laryngeal cancer. MATERIALS AND METHODS: Medical records of 91 patients who underwent total laryngectomy with thyroidectomy were retrospectively reviewed. Demographical, clinical, and histopathological characteristics of the patients were noted. Kaplan-Meier test was used for survival analysis. RESULTS: Histopathology reports revealed the prevalence of TGI as 14.3% (13/91). Survival analyses showed that TGI did not affect recurrence free (p = .078) and overall (p = .080) survival rates. CONCLUSIONS: Thyroid gland invasion is one of the characteristic features of locally aggressive laryngeal tumors. In this study, TGI is not a statistically significant prognostic factor that has impact on survival of the patients with locally advanced laryngeal cancer.

The influence of age and language on developmental trajectory of theory of mind in children with cochlear implants.

OBJECTIVE: The present study investigates if children with cochlear implants (CI) are associated with delayed development of Theory of Mind (ToM) and the differences in gain of ToM ability with respect to age, language and other aspects of CI. METHODS: One-hundred-eleven children with participation of their hearing parents, aged between 36 months and 132 months, who had congenital profound bilateral deafness and were unilateral CI users; plus 99 healthy children underwent 'Peabody Picture Vocabulary' and 'Sally-Anne' tests. A total of 77 children with CI (mean age: 76.51 months, 31 girls and 46 boys) and 82 healthy children (mean age: 72.41 months, 47 girls and 35 boys) were included in the analyses. Analytic comparisons were created between the controls and children with CI and between subgroups of CI users by univariate and multivariate analysis. The effects of age of hearing aid use, age of CI surgery, duration of CI use, language scores and the presence of risk factors, early rehabilitation with hearing aid and CI on the ToM development were analyzed. RESULTS: The Sally-Anne test success rates of 67.1% were significantly higher in controls than that of children with CI (49.4%) (p < 0.05). The mean age difference of the children, who were successful in Sally-Anne test was 5.33 months in favor of healthy controls. The ToM task success rates were 57.1% (24/42) and 40% (14/35) in children with early CI and late CI respectively. The children, who were good at language, were also better in Sally-Anne tests, but the mean Peabody Picture Vocabulary test scores were indifferent in the same age group with respect to the presence of CI use (p > 0.05). However, multivariate analysis presented the higher language scores as the only significant independent variable that has impact on the success in Sally-Anne test (p < 0.05). CONCLUSION: The results revealed that among all children, who did better in ToM were older in age and better in language skills. Children with CI also performed better in false-belief test depending on their language scores. Early CI surgery, older age, and hence longer CI use can provide a well-developed ToM for children with CI.

Necrotizing Fasciitis due to Candida Infection after Thyroid Surgery.

Surgical site infections (SSIs) after thyroidectomy are very rare as it is a clean case surgery, even the patterns for the use of prophylactic antibiotics is disputable. Cutaneous and subcutaneous tissue infections are the most common type of SSIs that develop due to the contamination of the skin flora pathogens during surgical incision. We report the case of a patient who, unlike the reports in the literature, developed necrotizing fasciitis due to Candida infection after total thyroidectomy. A 65-year-old male patient developed SSI progressing to necrotizing fasciitis four days after total thyroidectomy. Rapidly progressive necrosis was observed until antifungal treatment was initiated. Tissue defect eventually recovered with complete epithelization 40 days after the operation.

Evaluation of Lateral Temporal Bone Resection in Locally Advanced Tumours of the Parotid Gland.

This study evaluated the effects of lateral temporal bone resection (LTBR) on local tumour control in patients with locally advanced parotid gland tumours. The medical records of seven patients treated with radical parotidectomy combined with LTBR for locally advanced primary parotid tumour at the Otolaryngology Department of Dokuz Eylul University between January 1995 and December 2016 were retrospectively evaluated. Demographic variables, tumour characteristics, treatment properties, postoperative complications, follow-up durations and local, regional and distant recurrences were analysed. Before referral to our clinic, four patients had de novo primary parotid tumours, and three patients had a recurrence of primary parotid tumours. The histopathologic diagnoses were squamous cell carcinoma in two patients, and adenosquamous carcinoma, malignant myoepithelial carcinoma, adenocarcinoma, adenoid cystic carcinoma and spindle cell sarcoma in the other patients. During the follow-up period, one patient died due to postoperative pulmonary embolism in the first month, and four patients died due to distant metastasis without local or regional recurrences. LTBR combined with radical parotidectomy in locally advanced primary malignant parotid gland tumours is a feasible surgical technique for local tumour control. However, the most common cause of death in these cases is distant metastases, despite appropriate resection.

The Effect of Tympanic Membrane Perforation Site, Size and Middle Ear Volume on Hearing Loss.

OBJECTIVE: The aim of this study was to analyze the location and the size of perforation in cases with tympanic membrane perforation, its relation to the manubrium mallei and middle ear volume, and to investigate how these are correlated with the severity and frequencies of conductive hearing loss. METHODS: This prospectively designed study included the patients who presented to the the Department of Otorhinolaryngology at the Dokuz Eylül University with hearing loss or tinnitus complaints in the period from June 2014 through June 2017 and were identified to have tympanic membrane perforation in their otoscopic examination. Patients who underwent myringoplasty and type 1 tympanoplasty and whose air-bone gap was found lower than 10 dB in the postoperative audiological examination were included in the study. Effects of the perforation size, the perforation site, and the relationship of the perforation with the manubrium, as well as the effects of the middle ear volume on the severity and frequency of conductive hearing loss were compared. RESULTS: The study included 44 ears of 38 patients (13 male and 25 female) of whom six had tympanic membrane perforation in both ears. Air conduction threshold and air-bone gap were significantly found higher if the perforation area was wide (p<0.05), the perforation involved both the anterior and the posterior quadrants (p<0.05), had contact with the manubrium mallei (p<0.05), and the middle ear volume reduced (p<0.05). CONCLUSION: Solely tympanic membrane perforation affects hearing function; nevertheless, hearing function are better in cases, which have perforations small in size, no contact with manubrium mallei and well pneumatized middle ears.

Metastatic Renal Cell Carcinoma of the Nasal Septum: A Case Report.

Metastatic lesions of the nasal cavity and paranasal sinuses are rare tumors. Carcinomas originating from intrapelvic organs play an important role in the differential diagnosis of these masses because of their paradoxic spread to the head and neck region. In this study we report a case with metastatic renal cell carcinoma of the caudal nasal septum.

Sound energy absorbance characteristics of cartilage grafts used in type 1 tympanoplasty.

OBJECTIVE: The purpose of this prospective case-control study is to evaluate the sound energy absorbance characteristics of cartilage grafts in patients, who have undergone type 1 cartilage tympanoplasty. METHODS: Thirty-four operated ears of 32 patients and 70 ears of 35 control subjects were included. Differences of pure-tone audiometry thresholds and wideband ambient-pressure absorbance ratios with respect to the graft material, graft thickness, cartilage surface area ratio and elapsed time after surgery were analyzed. Receiver operating characteristics curve was generated to detect the absorbance level at which the reconstructed tympanic membrane behaves as 'near-normal tympanic membrane'. RESULTS: In the surgical group, wideband energy absorbance ratios at all 1/2-octave band frequencies were significantly worse than normal ears. Energy absorbance ratios at 2000 and 2828Hz frequencies were higher in patients with tragal cartilage grafts. Higher absorbance ratios at 250-750Hz range were obtained in patients with 400µm cartilage graft thickness, <50% cartilage surface area ratio and ≥5 years since surgery. A multivariate generalized linear model revealed common effects of the independent variables at 8000Hz. The receiver operating characteristics analysis generated a cut-off level of 63.20% of sound energy absorbance at 1400Hz with 83% sensitivity and 88% specificity. CONCLUSION: Even though no differences in hearing thresholds were observed; graft material, graft thickness, cartilage surface area ratio and elapsed time after surgery affected the course of sound energy absorbance after type 1 cartilage tympanoplasty as evidenced by wideband tympanometry.

Cochlear and Vestibular Effects of Combined Intratympanic Gentamicin and Dexamethasone.

OBJECTIVE: The aim of this study is to evaluate the effects of an intratympanic gentamicin-dexamethasone combination on the inner ear. MATERIALS AND METHODS: Twenty-six Wistar albino rats were divided into four groups: Group I (Control), group II (Intratympanic dexamethasone; ITD), group III (Intratympanic gentamicin; ITG), and group IV (Intratympanic gentamicin and dexamethasone; ITGD). On the first day after basal auditory brainstem response (ABR) measurements, the ITG group received 0.03 mL of intratympanic gentamicin (26.7 mg/mL). Intratympanic injection of 0.06 mL of a solution containing 13.35 mg/mL gentamicin and 2 mg/mL dexamethasone was performed in the ITGD group. 0.03 mL of physiological intratympanic serum and dexamethasone (4 mg/mL) was applied in control and ITD groups, respectively. On the 7th day, ABR measurements were repeated and vestibular functions were evaluated. On the 21th day, ABR and vestibular tests were repeated, and the animals were sacrificed for histopathological investigation. RESULTS: The ITG group's hearing thresholds deteriorated in all frequencies. The ITGD group's hearing thresholds were significantly better than the ITG group, except at 8 kHz on the 7th day and in all frequencies at the 21th day measurements. The vestibular function scores of the ITG and ITGD groups were higher than the controls. Apoptotic changes were seen in cochlea, spiral ganglion, and vestibule of the ITG group. Cochlear and vestibular structures were well preserved in the ITGD group, similar to the controls. CONCLUSION: The ITGD combination led to a significant hearing preservation. Although in subjective vestibular tests, it seemed that vestibulotoxicity was present in both ITG and ITGD groups the histopathological investigations revealed no signs of vestibulotoxicity in the ITGD group in contrast to the ITG group. Further studies using a combination of different concentrations of gentamicin and dexamethasone are needed.

Analysis of Otologic Injuries Due to Blast Trauma by Handmade Explosives.

OBJECTIVE: The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations. METHODS: Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified. RESULTS: Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed. CONCLUSION: Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma.

Unilateral Pedunculated Lymphangiectatic Fibrolipomatous Polyp of the Palatine Tonsil: A Rare Case.

Lymphangiomatous polyps are rare benign hamartomatous tumors of the palatine tonsils that can cause significant distress to the patients such as sore throat, foreign body sensation, a lumpy feeling in the throat region, dysphagia, and eventual suffocation. In this paper, the case of a 17-year-old male who came to the outpatient clinic with a complaint of difficulty in swallowing, eventual vomiting, and occasions of hematemesis is presented. On physical examination, the patient had a smooth-surface, polypoid, pedunculated tumoral lesion originating from the middle pole of the left palatine tonsil and protruding into the oropharyngeal isthmus. The patient underwent left tonsillectomy. Histopathological examination of the surgical specimen showed typical features of a lymphangiectatic fibrolipomatous polyp. The case reported herein with the brief literature review points out the clinical and the benign, non-neoplastic characteristics of the lymphangiectatic fibrolipomatous polyp, which can be cured by surgical excision along with tonsillectomy.

A Case of Ameloblastic Fibroodontoma Extending Maxillary Sinus with Erupted Tooth: Is Transcanine Approach with Alveolectomy Feasible?

Ameloblastic fibroodontoma (AFO) is a rare entity of mixed odontogenic tumors and frequently arises from posterior portion of the maxilla or mandible in first two decades of life. Herein, a 35-year-old woman with a noncontributory medical history who presented with a progressive left maxillary toothache, left maxillary first molar tooth mobility, and swelling in the left maxillary molar area for the last 2 months was reported. Radiologically, a tumor that originated from periapical area of the second mature molar teeth of maxilla was seen and additively unerupted tooth was not detected. The histopathologic examination revealed AFO. The patient is disease-free for five years after treated with limited segmental alveolectomy combining with Caldwell-Luc procedure.

Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients.

OBJECTIVE: The aim of this study was to investigate the proliferative and apoptotic activity of middle ear cholesteatoma in pediatric and adult patients, in addition to comparing its histopathological aspects and the severity of advanced bone destruction. MATERIALS AND METHODS: Medical records of 223 patients treated for chronic otitis media with cholesteatoma at the Otolaryngology Department of Dokuz Eylul University between January 1992 and December 2013 were retrospectively evaluated. Sixty-one patients subjected to tympanomastoidectomy due to middle ear cholesteatoma, with sufficient specimens for histopathological examination, were included in the study. Sections of archived tissues in paraffin blocks were subjected to new histopathological examinations. The proliferative and apoptotic activities of cholesteatoma were determined by immunohistochemical staining for epithelial thickness (ET), and Ki-67 and caspase-3 expression. A novel scoring system, the Bone Erosion Score (BES), was developed to estimate the severity of bone destruction. The Austin-Kartush classification score (AKCS) was also calculated. RESULTS: ET and Ki-67 expression was higher in adult patients than in the pediatric patients (p=0.009 and 0.01, respectively); however, caspase-3 immunopositivity did not show any significant intergroup differences (p=0.106). The differences in AKCS and BES between pediatric and adult patients were not statistically significant. According to the correlation analysis, a significant positive correlation was observed between AKCS and BES (p=0.001), and between ET and Ki-67 expression (when histopathological data were compared) (p=0.001). CONCLUSION: The proliferative activity of cholesteatoma was higher in adult patients. Therefore, these findings do not support the theory that the aggressive clinical course of cholesteatoma in pediatric patients is correlated with its histopathological characteristics.

The treatment of pharyngoesophageal perforation following anterior cervical spine intervention.

OBJECTIVE: We aimed to investigate the diagnostic and therapeutic approaches in pharyngoesophageal perforation (PEP) following anterior cervical spine intervention (ACSI). METHODS: We reviewed the records of four patients with PEP after ACSI. Symptoms, physical examination findings, imaging results, treatment, and follow-up characteristics were evaluated. RESULTS: All four patients had undergone ACSI for either cervical trauma or cervical disc herniation with cervical cage reconstruction. Symptoms developed within the first 10 days of the postoperative period in three patients, and in the eighth month in one patient. Mucosal defects were detected during neck exploration in three patients. Reconstruction with primary suture and a local muscle flap was utilized in two patients. Three patients were discharged 3-8 weeks after surgical treatment. CONCLUSION: In cases of PEP after ACSI, a good prognosis can be achieved when symptoms are detected in the early period and reconstruction with local muscle flap is applied.