Treatment of Congenital Choanal Atresia via Transnasal Endoscopic Method.

OBJECTIVES: Congenital choanal atresia (CCA) is a very rare abnormality of the nose, but in the case of bilateral presence, it becomes a life-threatening malformation. Various surgical treatment options, such as transpalatal, transseptal, and open rhinoplasty techniques, as well as the transnasal approach, have been defined for the repair of CCA. In this study, the authors intended to evaluate the outcomes of transnasal endoscopic surgery for CCA, and stent implementation's impact on surgical success. METHODS: Patients who were admitted to the Otorhinolaryngology Department of Gaziantep University and patients who had not undergone CCA surgery before were included in the study. Patients who underwent transnasal endoscopic choanal atresia surgery (TECAS) were advised to have regular nasal endoscopic examinations performed at check-ups; after a 6-month follow-up period, surgical results were evaluated concerning whether stenosis had occurred or not. RESULTS: Of the 48 patients who underwent TECAS after a minimum 6-month follow-up period, 34 of patients revealed no stenosis, so the overall surgical success rate was 70.8%. Fourteen (29.2%) patients who underwent TECAS developed stenosis and required revision surgery. CONCLUSIONS: Transnasal endoscopic choanal atresia surgery is the most preferred approach for CCA repair and has many advantages, such as excellent vision, shorter operative time, minimal bleeding, and minimum complication. Despite advances in endovision systems and surgical instruments, stenosis is the most challenging problem after TECAS, so new treatment strategies should be developed to prevent stenosis.

Oxidative stress in otosclerosis.

OBJECTIVES: Otosclerosis is a disease involving abnormal bone turnover in the human otic capsule that results in hearing loss. Several hypotheses have been suggested for the etiopathogenesis of otosclerosis; however, its etiology remains unclear. METHODS: This study evaluated the correlation between otosclerosis and levels of paraoxonase-1 (PON1), arylesterase, total antioxidant status, total oxidant status (TOS), oxidative stress index (OSI), total sulfhydryl (-SH) groups, lipid hydroperoxide, and ceruloplasmin in the serum of otosclerosis patients and healthy subjects with respect to oxidative stress. RESULTS: In our study, TOS and OSI levels were higher in the otosclerosis patients than in the controls. The PON1 levels showed that oxidative stress was severe, and as a result, antioxidants were consumed and depleted. DISCUSSION: When an imbalance between oxygen free radical production and antioxidative defense mechanisms occurs, reactive oxygen species levels may increase, which in turn may damage cells and tissues through the peroxidation of phospholipid membrane structures. The body initially responds with increased antioxidant production, but if the oxidative stress is severe, decreased antioxidant levels may result. This study reports expression levels of oxidative stress species in otosclerosis patients.

Masking Treatment and its Effect on Tinnitus Parameters.

OBJECTIVE: Tinnitus is described as the perception of sound without any external acoustic stimulation. Any pathology of auditory pathways or any system of the human body may result with tinnitus. The pathophysiology of tinnitus accompanying the disorders of auditory system is not fully understood and there is not any particular effective treatment method has been specified. Tinnitus masking therapy has been reported as an effective treatment modality in the treatment of tinnitus. In this study, the results of tinnitus masking treatment on the parameters were evaluated prospectively. PATIENTS AND METHODS: Patients with normal physical examination was enrolled in the study. Blood tests (complete blood count, biochemical analysis of lipid profile, and thyroid hormones), pure tone audiometry, tympanometric measurement of the middle ear pressure and stapedial reflexes were performed, Sixty six patients with normal results of blood tests and normal hearing thresholds with type A tympanogram were included. Tinnitus sufferers questionnaires (socio-demographics, clinical information, Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI) was filled, audiological tests were performed, tinnitus parameters (frequency, intensity, minimal masking levels, residual inhibition) were measured. After four weeks of the treatment the questionnaires were repeated. RESULTS: Masking treatment for tinnitus patients resulted with significant decrease in Tinnitus Handicap Inventory and VAS scores. After four weeks of the masking treatment the questionnaire was repeated. Twenty patients did not respond to treatment. CONCLUSION: Masking therapy is one of the most effective methods of treatment for tinnitus patients. Masking therapy, that is not invasive and cost-effective has an important place in the treatment of tinnitus. Especially in a short time provides a significant reduction in tinnitus parameters.

Isolated sphenoid sinus disease: An overlooked cause of headache.

OBJECTIVES: The aim of this study was to evaluate patients who underwent endoscopic sphenoid sinus surgery for isolated sphenoid sinus disease. We also investigated the impact of sphenoid sinus surgery on headache intensity. MATERIAL AND METHODS: Twenty-one consecutive patients who underwent endoscopic sphenoidotomy for isolated sphenoid sinus disease were included in the study. Diagnosis of isolated sphenoid sinus pathology was based on history, physical examination, and radiologic evaluation. All patients had headache with various localizations. Pre- and postoperative headache intensity of patients was scored using a visual analogue scale (VAS). RESULTS: The most common location of headache was the vertex (24%). The preoperative and postoperative mean VAS scores for headache were 8.24 ± 0.94 and 2.67 ± 1.49, respectively. Statistical comparison revealed a significant improvement in headache intensity (p < 0.01). Polyps (33.3%) were the most common pathology, followed by inflammation (23.8%). CONCLUSIONS: The most common presenting symptom of isolated sphenoid sinus disease is headache. In this study, we demonstrated that headache induced by isolated sphenoid disease can be relieved by endoscopic sphenoidotomy. Sphenoid sinus disease should be considered in the differential diagnosis of patients presenting with subacute or chronic headache.

Effectiveness and Safety of Selective Neck Dissection in Lymph Node-Positive Squamous Cell Carcinoma of the Head and Neck.

The aim of this study was to investigate the effectiveness and safety of selective neck dissection in patients with lymph node-positive head and neck squamous cell carcinoma to determine regional control and survival rates. Eighty patients with lymph node-positive head and neck squamous cell carcinoma who underwent selective dissection were included in the study. Regional control, survival rates, and factors affecting survival were analyzed. Regional control was 90%, disease-specific survival was 93.4%, and the overall survival rate was 87.25%. T stage, N stage, age, and extracapsular spread were included in hazard regression models. None of the factors were statistically significant. Selective neck dissection is an effective and oncologically safe treatment option in selected cases. T stage, N stage, and extracapsular spread had no significant impact on disease-specific survival.

Evaluation of hearing loss in pediatric celiac patients.

OBJECTIVES: Celiac disease (CD) is a chronic immune-mediated enteropathy caused by the ingestion of gluten in genetically predisposed individuals. In some reports, sensorineural hearing loss (SNHL) has been identified as an extraintestinal symptom of CD. We aimed to further investigate the possible association between CD and SNHL by examining a greater number of pediatric CD patients. METHODS: The study was carried out from March to September 2014 and included 110 pediatric patients with biopsy-confirmed CD (220 ears) and 41 age- and sex-matched controls (82 ears); participants were evaluated by tympanometry and pure tone audiometry (frequency, 250-8000Hz frequency). RESULTS: Audiometric bone conduction thresholds were significantly different between the CD patients and the controls (p<0.05), but there were no significant differences in pure tone averages for air conduction (p>0.05). When the results for CD patients were analyzed according to duration of disease (≤36 months and >36 months), a significant difference in bone conduction thresholds (p<0.05) was noted, with significant increments at the later stages of disease. However, this difference was not sufficient to define clinical hearing loss, as the pure tone average thresholds remained below 20dB. CONCLUSION: These results indicate that subclinical hearing loss may be present in children with CD, which could presage more serious hearing impairments at older ages and later stages of the disease. Hearing screenings should be recommended for children with CD in order to prevent the potentially unfavorable effects of hearing loss on the emotional, behavioral, cognitive, and sensorimotor development of these patients.

Incidence and predictors of malignancy in children with persistent cervical lymphadenopathy.

OBJECTIVE: The aim of this study was to analyze the clinical and histopathologic aspects of persistent cervical lymphadenopathies in children. METHODS: This retrospective study included 98 children who underwent surgical excision for persistently swollen cervical lymph nodes between 2001 and 2013. Lymph nodes greater than 1.5 cm that persisted for more than 4 weeks and were unresponsive to an initial antibiotic treatment were considered "persistent". The largest lymph node with an abnormal ultrasonographic appearance was selected for surgical biopsy. The patients were divided into 2 groups according to the histopathologic outcome: benign or malignant. RESULTS: No significant differences were found between the groups regarding the mean size and mean duration of the swollen cervical lymph nodes (p = 0.147 and p = 0.446, respectively). The area under the ROC curve was 0.567 (95% confidence interval = 0.463-0.667, p = 0.259) for lymph node size and 0.507 (95% confidence interval = 0.404-0.609, p = 0.909) for the duration of the cervical lymphadenopathy. There was no significant difference in the presence of B symptoms between the two groups (p = 0.519). No significant difference was found between benign and malignant groups regarding bilaterality (p=0.913). CONCLUSIONS: The findings of our study demonstrated that the size and duration of cervical lymphadenopathy, bilateral or unilateral involvement and the presence or absence of B symptoms are not indicators of malignancy. We found a high incidence of malignancy in pediatric cervical lymphadenopathy cases in contrast to other current studies.

Management of upper aerodigestive tract amyloidosis.

OBJECTIVES: The aim of this study was to discuss the treatment options for upper aerodigestive tract amyloidosis. METHODS: Four patients with histologically confirmed amyloidosis were included in the study. All patients underwent surgical treatment. Three patients had laryngeal amyloidosis, and 1 patient had tonsillar amyloidosis. RESULTS: Two of the cases of laryngeal amyloidosis were successfully treated with a combination of surgery and radiation therapy. One case of laryngeal amyloidosis was treated with surgery alone. The tonsillar amyloidosis was removed by tonsillectomy. None of the cases showed systemic involvement. Long-term follow-up of the patients showed no recurrence or evidence of systemic disease. CONCLUSIONS: Surgical resection is the primary treatment for patients with upper aerodigestive tract amyloidosis. Radiation therapy is especially effective in cases of recurrent amyloidosis with submucosal involvement. Pedunculated polypoid lesions may be treated with surgery alone, and in cases of recurrence, irradiation following the surgical removal should be considered. Tonsillectomy is usually sufficient for treating tonsillar amyloidosis.

Association between the self-insertion of nasal and aural foreign bodies and attention-deficit/hyperactivity disorder in children.

OBJECTIVE: To investigate whether the prevalence of attention-deficit/hyperactivity disorder (ADHD) is higher in children presenting with nasal and aural foreign bodies than in the control group. METHODS: The present study was conducted between April 2012 and December 2012 and included 60 pediatric patients presenting with self-inserted nasal and aural foreign bodies and 50 healthy controls aged between 3 and 9 years. The Conner Parent Rating Scale (CPRS) and Turgay's DSM-IV based ADHD and disruptive behavior disorders screening scale (T-DSM-IV-Scale) were used to investigate ADHD. RESULTS: The difference between the patient group and the control group was significant with respect to the abnormal scores obtained from all the subscales (p < 0.05). In children between 5 and 9 years of age, the abnormal scores were significantly higher in the patients than the controls for all the subscales (p < 0.05). However, in children between 3 and 4 years of age, there were no significant differences between the patients and the controls for the scores obtained from all the subscales (p > 0.05). No statistically significant difference was found between the patients with a previous history of self-inserted foreign bodies and those without any history of foreign body insertion (p > 0.05). CONCLUSIONS: The findings of our study demonstrated a possible association between the self-insertion of nasal and aural foreign bodies and ADHD. Clinicians should be aware of the possible presence of ADHD in children, especially in those patients between 5 and 9 years of age who present with self-inserted nasal and aural foreign bodies.

Pediatric endonasal endoscopic dacryocystorhinostomy.

OBJECTIVE: Nasolacrimal duct obstruction is a relatively common problem among children. Although spontaneous resolution is possible and various conservative treatment options are available, dacryocystorhinostomy is recommended for persistent epiphora. The aim of this study was to report our experience of performing 83 procedures of pediatric endoscopic dacryocystorhinostomy. METHODS: This retrospective study included 71 children who underwent endonasal endoscopic dacryocystorhinostomy between 2000 and 2011. Thirteen of these children had bilateral procedures. The diagnosis of nasolacrimal duct obstruction was based on the presence of eye discharge, the patient's history obtained from his or her parents and the results of testing the patency of the nasolacrimal canal by irrigating the lacrimal sac. The procedure was considered to be successful if the patient's eye discharge was completely resolved and the dacryocystorhinostomy ostium was patent at end of the postoperative first year. RESULTS: Eighty-three dacrycystorhinostomy procedures were performed in 71 children. There were 35 (49.3%) male and 36 (50.7%) female patients. The age of the patients ranged between 11 months and 14 years, with a mean of 8.9 years. The mean follow-up period was 27.1 months (range of 14-84 months). The overall success rate for primary endoscopic dacryocystorhinostomy was 92.7%. No major complications were encountered in any of the surgical procedures. CONCLUSION: Pediatric endonasal endoscopic dacryocystorhinostomy is a safe and effective procedure to correct nasolacrimal system obstruction in cases that are unresponsive to conservative treatments. It has a high success rate and a low incidence of complications.

Systemic steroid versus combined systemic and intratympanic steroid treatment for sudden sensorineural hearing loss.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of oral steroid treatment versus combined oral and intratympanic dexamethasone injection for idiopathic sudden sensorineural hearing loss. METHODS: This was a retrospective case review in which 30 patients in the oral steroid group and 39 patients in the combined oral and intratympanic steroid injection group were compared. RESULTS: The comparison of the initial pure tone audiometry (PTA) threshold results revealed a significant difference between the systemic steroid (SS) group and the systemic and intratympanic steroid group. The initial PTA was 74.33 ± 22.64 dB (mean ± SD) in the SS group and 87.49 ± 26.22 dB (mean ± SD) in the intratympanic steroid group. The difference in the initial PTA results was statistically significant between the SS group and intratympanic steroid group (P < 0.05, P = 0.032). The pure-tone gain in the SS group was 20.97 ± 27.47 dB (mean ± SD), and that of the group treated with both systemic and intratympanic steroids was 19.36 ± 22.16 dB (mean ± SD) (P = 0.49). CONCLUSIONS: The results of this study indicate that, in sudden sensorineural hearing loss, the administration of intratympanic steroids in conjunction with SS therapy appears to have the same effect on the restoration of hearing "as the effect obtained using SS therapy alone."

Late metastasis of an intracranial meningioma to the hard palate.

Meningiomas are benign neoplasms that arise from cellular elements of the meninges. Although meningiomas are usually considered as benign tumors, they have a potential to become aggressive and to metastasize to the extracranial structures. Distant metastasis most commonly occurs in lung, liver, and long bones. We present an extremely rare case of a delayed metastasis of a recurrent intracranial meningioma to the hard palate 19 years after the initial diagnosis. The patient underwent surgical excision without any complication and follow-up showed no recurrence.

Paranasal sinus osteomas.

Osteoma is the most common benign tumor of the paranasal sinuses. They remain asymptomatic until the tumor reaches a certain size. Although the etiology of the osteomas is controversial, embryologic, traumatic, and infective theories have been proposed. Osteomas may be discovered at any age but are usually found during the fourth and fifth decades, and there is a male preponderance. In this retrospective study, we analyzed 25 patients with paranasal sinus osteomas who were treated surgically between 2005 and 2011. Age and sex of the patient, size and location of the tumor, clinical presentation, type of surgical approach, duration of follow-up, outcome, and any intraoperative or postoperative complications were obtained from the medical records of the patients. Diagnosis of osteoma was based on computed tomography findings and confirmed histopathologically in all cases. There were 9 men (36%) and 16 women (64%) with a mean age of 38.7 years. Tumor localization was divided as follows: ethmoid sinus in 14 patients (56%), frontal sinus in 9 patients (36%), and maxillary sinus in 2 patients (8%). Mean tumor size was 2.04 cm, ranging from 0.5 to 6.5 cm. External approach was used in 9 cases and endonasal endoscopic surgery was performed in 19 cases. Combination of endoscopic surgery and external surgery was performed in 3 cases. After at least 6 months of follow-up, all patients were symptom-free except 2 patients who underwent revision surgery. These 2 patients were also asymptomatic following revision surgery. Although there is an increasing trend to endoscopic surgery, external approach is recommended in large frontal osteomas and ethmoid osteomas with lateral extension and in case of intracranial or intraorbital involvement.

Efficiency of endoscopic imaging in repetitive probing following unsuccessful probing.

PURPOSE: To show the efficiency of repetitive probing performed with intranasal endoscopic imaging in cases who underwent unsuccessful probing and the accompanying nasal pathologies. METHODS: Eighty-four eyes of the 64 patients in whom primary probing was found to be unsuccessful were included in the study. Cases were divided into 3 groups, depending on the number of unsuccessful attempts (1 [group 1], 2 [group 2], and 3 [group 3] unsuccessful probings). Diagnosis of congenital nasolacrimal duct obstruction was confirmed by history taking, clinical examination, and fluorescence disappearance test. All cases underwent nasal endoscopic-assisted probing and were followed up on the first week, first month, and third month following the procedure. RESULTS: There were 50 eyes in group 1, 23 in group 2, and 11 in group 3. The causes of failure that were determined with endoscopy were as follows: functional insufficiency 8.3%, lower nasal concha tension 4.7%, thin membrane in Hasner valve 3.6%, thick membrane and fibrosis in the distal side of the duct 21.4%, probe progressed submucosally on the nasal wall 33.3%, different exit location in the nose 20.2%, nasal mucosa ballooning in the distal side of the duct 4.7%, mucocele 2.4%, and nasal polyposis 1.2%. The success rate in the groups was estimated as 86% in the first group, 69.5% in the second group, and 54.5% in the third group. CONCLUSIONS: Performing the repetitive probings via nasal endoscopy provided information about the location and the shape of the obstruction and the opportunity to approach, according to the cause of the failure.

Intra- and postoperative electrically evoked stapedius reflex thresholds in children with cochlear implants.

OBJECTIVES: The aim of this study was to investigate whether there is a significant correlation between intra- and postoperative electrically evoked stapedius reflex thresholds (eSRTs) in children with cochlear implants. METHODS: Sixty-five pediatric cochlear implant users were included in this study. All patients had congenital prelingual hearing loss. The round window approach was used in all patients. The eSRTs were intraoperatively measured using the 1st, 3rd, 6th and 12th electrodes of the cochlear implant. The measurements taken during the first fitting of the device were taken again one month after surgery. We used paired-sample t-tests to determine the correlation between intra- and postoperative eSRTs. RESULTS: The eSRT analysis revealed a statistically significant difference between the intra- and postoperative thresholds. A correlation analysis did not reveal any correlation between intra- and postoperative eSRTs. CONCLUSION: Intraoperative eSRT measurements were unable to predict early postoperative eSRTs.

Reconstruction of lower lip with myomucosal advancement flap.

BACKGROUND: In this article, a new surgical procedure that can be used for reconstruction of lower lip defects of any size is described. METHODS: In this prospective study, the surgical procedure was applied in 16 patients. In this procedure, the mucosa and the orbicularis oris muscle of the lower lip are repaired with a composite flap, and the skin defect is closed using local skin flaps. The patients were assessed in terms of complications, mouth opening, sphincter function of the mouth, and sensation in the lower lip. RESULTS: The aesthetic results obtained in all patients were satisfactory. Sufficient oral sphincter function was achieved in all patients. CONCLUSION: Reconstruction of lower lip defects using the procedure described here can be performed in patients with lower lip defects of any size as long as the mucosal and skin repair lines are not superimposed. This procedure yielded good sphincter function and aesthetic results.

Intraoperative electrically evoked stapedius reflex thresholds in children undergone cochlear implantation: round window and cochleostomy approaches.

OBJECTIVES: To study the best electrically stimulation in cochlear implant surgery with round window (RW) and Promontory cochleostomy approaches with electrically evoked stapedius reflex thresholds (ESRT) intraoperatively. METHODS: Thirty-nine children underwent CI surgery were included for this study. The surgical procedures consisted of RW and Promontory cochleostomy. ESRT for each 1st, 3rd, 6th and 12th electrodes (E) were determined. Statistical evaluation was done for the comparison of the thresholds and duration times for both groups. RESULTS: The duration times of ESRT for E1, E3, E6 and E12 electrodes was shorter in RW group compared with the Promontory group (p<0.05). The statistical evaluation of ESRT measurements of E1, E3, E6 found p<0.001 and E12 electrode p<0.05 in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. CONCLUSION: The duration of electrically stimulation thresholds were shorter in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. RW insertion offers best electrically stimulation relative to electrode insertion via a promontory cochleostomy.

Use of rotation flap in repair of cleft palate and velopharyngeal insufficiency.

Although cleft palate anomaly is frequent, the criterion standards in surgical treatment have not been determined yet. There are a few techniques described for cleft palate repair owing to the limited tissue in the palatal mucosa, the rigid structure of the palatal mucosa, and the limited vascularity of the hard palate. In this study, a novel cleft palate repair technique based on separating the soft palate from the hard palate as a musculomucosal flap and using it as a rotation flap has been described. The operation is evaluated individually for each anomaly because variations occur in the surgical technique according to the extension of the cleft toward the teeth in the palate. This operation was performed on a total of 28 patients (17 girls and 11 boys) aged between 1.5 and 16 years and presented to our clinic. Patients were assessed for speech analysis outcomes, tympanogram values, hearing functions, magnitude of palatal lengthening during the operation, and rate of fistulae. Statistically significant differences in values of the speech analysis and the audiometric assessment were determined between before and 6 months after surgery. Complete recovery of otitis was observed 1 month after surgery without another treatment in 9 (42.8%) of 21 patients who were detected to have serous otitis media preoperatively. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all types of cleft palate, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this technique.

Giant pleomorphic adenoma of the nasal septum.

Pleomorphic adenoma is the most common benign tumor of the salivary glands, mainly arising from major salivary glands such as parotis and submandibular gland. In rare cases, however, pleomorphic adenoma presents in various unusual sites such as the nasal cavity, paranasal sinuses, hypopharynx, pharynx, larynx, trachea and lacrimal glands. We present a rare case of 80-year-old woman with pleomorphic adenoma of the nasal cavity.

Electrophysiologic assessment of the subclinical changes in facial functions after parotidectomy.

OBJECTIVE: Our objective was to evaluate whether there was a subclinical change in the functions of the facial nerve after parotidectomy. METHODS: Facial nerve functions of 21 patients who had parotidectomy between January 1999 and December 2003 were assessed using electromyography (EMG) at least 5 years after the surgery. RESULTS: There was no significant difference between both sides of the face in the EMG amplitudes (P > 0.05) except for the amplitudes obtained from the site of nasolabial sulcus (P < 0.05). In the patients who underwent total parotidectomy, the EMG amplitudes were significantly different for both sides of the face (P < 0.05). No significant difference was found in the comparison of other measurements performed by EMG. CONCLUSIONS: Tumor histopathologic type (benign or malignant) and type of parotidectomy (superficial or total) do not cause a subclinical dysfunction of the facial nerve after parotidectomy in the patients who also have clinically normal facial functions. The only exception to this contention is the subclinical dysfunction in nasal branches of the facial nerve in total parotidectomy cases.