Report of a rare case of vocal fold carcinoma that was obscured by a prominent vocal fold polyp.

We report the case of a 56-year-old man who was evaluated for hoarseness. Telescopic and fiberoptic examination revealed a huge, pedunculated polyp that obscured the vocal folds. Upon further examination, microlaryngoscopy revealed a coexisting superficial irregular lesion on the upper surface of the left vocal fold, which was identified as a microinvasive carcinoma. This unusual presentation emphasizes the importance of a microlaryngoscopic examination.

Adenoids and otitis media with effusion: a morphological study.

PURPOSE: Adenoidectomy, especially for the treatment of suppurative otitis media, has been used for a very long time. In this study, the role of adenoids in the origin of otitis media with effusion was investigated by using light microscopy, immunocytochemistry, enzyme chemistry, and electron microscopy. MATERIALS AND METHODS: A group of 28 children with otitis media with effusion (OME) was identified. Ages ranged from 3 to 12 years. A control group of 10 age-matched children without any middle ear and upper respiratory tract infection served as the basis for comparison. Specimens obtained at surgeries from both groups were divided into groups for light microscopy, immunocytochemistry, enzyme cytochemistry, and electron microscopy and then all were examined blindly. Also, quantitative analysis of antigen-presenting cells was performed blindly on 10 patients and 10 controls. RESULTS: There was an increase in the number of lymphocytes, mast cells, plasma cells, macrophages, dendritic cells, and M cells in the adenoids of patients with OME when compared with the normal cases. Stratified squamous epithelial areas, collagenous fibers, and fibrocytes were also increased in the patient group. Antigen-presenting functions of epithelial cells are shown by major histocompatibility complex (MHC) class II positivity of some ciliated-columnar epithelial cells in the patient group. CONCLUSION: Adenoid tissues of patients with OME in this study seem to be infectious foci, aggravating immune reactions, which might attack the middle ear through an ascending route.

Pharyngocutaneous fistula following laryngectomy.

BACKGROUND: Pharyngocutaneous fistula (PCF) following laryngectomy is a serious complication, and its incidence varies from 7.6% to 50%. Despite the relative frequency of this complication, there is still uncertainty about the predisposing factors. METHODS: A retrospective study was performed in 295 patients who underwent total laryngectomy. RESULTS: Of the 295 patients, 37 (12.5%) developed PCF. The contributing factors,--such as early oral feeding postoperatively, prior radiotherapy or tracheostomy, accompanying neck dissection,--and the surgical technique failed to show a statistically significant effect. There was statistically significant association between tumor size and PCF formation. Also, when the suture materials used for the closure of the pharynx were compared, catgut showed a higher rate of PCF formation than vicryl (p < .05). CONCLUSIONS: The vicryl, when used as a suture material for the closure of the pharynx, seemed to decrease the fistula rate significantly, compared with catgut. Also, tumor stage was found to have a significant role in PCF formation, but no statistical significant difference could be demonstrated for other investigated parameters. We believe that after total laryngectomy, oral feeding can be started at the third postoperative day without increasing morbidity, which makes the patients feel more comfortable and confident without nasogastric tube.

Ultrastructure of the nasopharyngeal orifice epithelium of the eustachian tube in otitis media with effusion.

Epithelial changes in nasopharyngeal orifice of eustachian tube in 15 patients with otitis media with effusion (OME) were studied. Ultrastructural examination of the epithelium revealed distinct alterations in the ciliated cells, intermediate cells and in the columnar cells with microvilli. The ciliated cells were the predominant cell type in the epithelium and were characterized by compound cilia and apical cytoplasmic bulgings with fine granular content. The intermediate cells showed more prominent lateral cytoplasmic bulgings. Cytoplasmic bulgings of both cell types eventually pinched off and set free as cytoplasmic bodies, similar to the cytoplasmic bodies derived from lymphocytes. As a result of epithelial destruction, the lumen of nasopharyngeal orifice was occupied by epithelial cellular debris among which leucocytic cells and cytoplasmic bodies with fine granular content. This accumulation in the lumen probably developed as a result of defective mucociliary activity which is due to compound cilia formation in the ciliated cells. Moreover, ultrastructural resemblance of cytoplasmic bodies derived from ciliated cells, intermediate cells and leucocytic cells indicates the possible role of these cells in common immune defence mechanisms in chronic otitis media with effusion.

Hearing loss in Behçet's disease.

In order to determine the characteristics and incidence of hearing loss in Behçet's disease, 72 consecutive cases and 72 sex- and age-matched normal subjects were submitted to this study. Detailed audiologic tests were performed in all cases. Twenty patients (27%) showed some degree of hearing loss; but in only 7 patients (9%) was the average of the frequencies between 500 to 4,000 Hz more than 25 dB hearing level, and the cochlear function of 43 patients (59%) was within the 25-dB range in all frequencies. The averaged pure tone audiograms of the two groups showed a statistically significant hearing loss in the Behçet's group. No relationship could be found between hearing loss and other system involvements. There was no correlation between hearing loss and duration of the disease, but the mean age of the Behçet's patients with hearing loss was found to be significantly higher than the mean age of the patients without hearing loss.

Serum levels of tumor necrosis factor in squamous cell carcinoma of the head and neck.

PURPOSE: Tumor necrosis factor (TNF)-alpha is a multifunctional cytokine that influences the clinical outcome in a number of diseases. This study was undertaken to evaluate its role in the differential diagnosis of malignant and benign tumors and in the follow-up of patients. We also studied the correlation of TNF-alpha levels with the stage and differentiation of the diseases. METHODS: In this study, serum levels of TNF-alpha are determined by the immunoradiometric assay method in 26 patients with head and neck cancer, and results are compared with 8 control patients with benign diseases. In both groups, serum samples were taken before and after the therapy. After centrifugation, the sera was stored at -70 degrees C until analyzed. TNF-alpha levels were measured by TNF-alpha immunoradiometric assay (IRMA) kit (Medgenix, Diagnostics SA, Belgium). RESULTS: The pretreatment mean value of TNF-alpha in the study group (814.1 pg/mL) was almost 100 times higher than in the control group (8.6 pg/mL) (P = .001). It was also noted that posttreatment mean value (94 pg/mL) was significantly lower than pretreatment mean value in the study group (P = .001). No statistically significant difference was found between serum TNF-alpha levels and the stage and differentiation of the tumor. CONCLUSION: The serum levels of TNF-alpha may be an efficient tumor marker in the diagnosis of patients with head and neck cancer.

Acyclovir in the treatment of recurrent respiratory papillomatosis: a preliminary report.

INTRODUCTION: In this study, we evaluate the effect of acyclovir in the treatment of recurrent respiratory papillomatosis (RRP), in addition to CO2 surgery. MATERIALS AND METHODS: We include 12 patients who had aggressive RRP and required at least three prior endoscopic surgeries in this study. Acyclovir treatment started the day after the surgery. During the planned treatment period of 6 months, patients older than 5 years were asked to take the daily dose of 800 mg, and those younger than 5 years were asked to take 400 mg. RESULTS: Nine of 12 patients were disease free during the follow-up periods, which ranged from 14 to 25 months with a mean of 18 months. Only 3 patients who used the drug inadequately required reoperation. CONCLUSION: Because of the specific viral origin of RRP, we hope that addition of acyclovir to surgery will preclude or at least decrease the number of recurrences in this potentially fatal disease.

Mycobacterial species causing cervicofacial infection in Turkey.

The aim of the study was to determine the mycobacterial species causing cervical lymphadenitis at Cukurova University Hospital, Adana, Turkey. To this end, culture and differential tests were performed on excisional or incisional biopsy specimens from patients with mycobacterial cervical disease (MCD). The diagnosis was confirmed by skin tests, histopathological examination and positive cultures. In 15 of 40 cases diagnosed as MCD, mycobacteria were isolated in Lowenstein-Jensen medium. The etiological agents were tuberculous mycobacteria (Mycobacterium tuberculosis in 9 cases and M. bovis in 3 cases). Of the 3 non-tuberculous cases, 2 were due to M. kansasii and the other to M. fortuitum. Antituberculous chemotherapy was given in all cases over an average period of 18 months. A combination of three of four drugs was used including isoniazid, ethambutol, rifampin and/or streptomycin. At the end a follow-up period of at least 3 years, there were no recurrences or persistences of infection and no surgical treatment was necessary to remove residual lymph nodes.

An unusual case of Xanthoma disseminatum.

A 10-year-old boy was admitted to the University Hospital complaining of exhaustion, night sweats, coughing and dyspnea. Physical examination, laboratory findings and histopathological examination led to the diagnosis of Xanthoma disseminatum. Because of dyspnea a tracheostomy was performed 3 months before diagnosis was made. Outline of treatment and management of this patient is discussed in this paper.

Changes of middle ear mucosa in secretory otitis media treated with ventilation tubes.

The present study was designed to obtain the precise ultrastructural status of the middle ear mucosa of patients to whom ventilation tubes were applied for the treatment of secretory otitis media (SOM). This study comprised 14 children with SOM aged 5-11. Normal epithelium obtained from otosclerotic patients as controls was composed of three main cell types; basal, ciliated, and secretory. Electron microscopic observations revealed that ciliated cells were almost completely absent in the epithelium of patients with SOM. Secretory cells, on the other hand, were noted to be increased in number with cytoplasmic features indicating active secretory phase; abundant secretory granules in these cells featured both serous and mucoid characteristics. Following the application of ventilation tubes, the micrographs exhibited a vast number of ciliated cells. Furthermore, the secretory cells were less conspicuous and the secretory granules were mostly serous in type. The ultrastructural findings of this investigation strongly suggest that the application of ventilation tubes in cases of SOM stimulates ciliated cell regeneration, inhibits secretion of mucoid material, and activates serous secretion; all of which eventually shorten the recovery period.

Alveolar soft part sarcoma of the tongue.

In this report a 13-year-old girl with characteristic clinical and pathological features of alveolar soft part sarcoma of the tongue is presented. Alveolar soft part sarcoma is a rare malignant tumor of unknown origin. Forty eight cases of alveolar soft part sarcoma have so far been reported in the head and neck region. Median survival reported for all sites of the body is 79 months following various modes of therapy. In this case, the treatment was surgical excision of the mass combined with radiotherapy and chemotherapy. The patient has been asymptomatic for the past 12 months.

Extramedullary leukemia with central facial palsy originated from poorly differentiated abdominal lymphoma.

An 8-year-old boy was presented with central facial palsy caused by extramedullary leukemia which had originated from poorly differentiated abdominal lymphoma. On cerebral tomographic scanning, there were adherences in the basal area of the brain. The occurrence of central facial palsy is very rare in childhood leukemia. However, in this case facial palsy was central in type and appeared as the presenting sign. The occurrence of central facial palsy was confirmed by the absence of clinical, radiological and audiological signs of peripheral involvement. The contralateral stapedius reflex test (500, 1000, and 2000 Hz) was present in this case.

Hereditary macrothrombocytopathia, deafness and nephritis (Epstein's triad).

Epstein's triad is a syndrome with a combination of hereditary macrothrombocytopathia and progressive sensorineural hearing loss and nephritis. This syndrome is rare and may be inherited as dominant trait or sex-linked or new mutation. But the true mode of this syndrome is still questionable. Bilateral sensorineural hearing loss is progressive and seems not to be related to the severity of bleeding episodes and renal failure. An 8-year-old boy with these findings is presented and discussed in this article.

Positional vertigo.

Different forms of positional nystagmus, particularly the continuous (type I) variety, were found in 86 consecutive patients admitted to general and neurological hospitals. This series is compared with 365 patients with paroxysmal (type II) and 23 patients with type III positional nystagmus. In this series of 32 of the patients with continuous type I positional nystagmus (including 15 patients with head injury) and 18 of the patients with paroxysmal type II nystagmus were found to have central lesions.

A comparison of methods of extra temporal facial nerve repair.

The development during the past 100 years of methods of repair of the divided facial nerve is discussed, from the early attempts to bring the nerve ends together inside a tube of vein. The success of the repair is enhanced by the care of the blood supply to the nerve and by measures to avoid scar developing between the ends of the nerve. Rest of the suture line is aided by the support of some form of tube, but unless this latter is kept below I cm. in length interference with the radial blood vessels to the nerve occurs. Intubation also encourages parallel growth of the nerve fibres and discourages fibroblast proliferation. Animal experimentation shows that the results when a soft silicone tube of special shape is used are superior to those obtained if the nerve is left free in the tissues, buried in muscle, or placed inside a vein.