The Effect of Bevacizumab and Propranolol on Nasal Polyposis.

Objective: This study aims to evaluate the effects of bevacizumab and propranolol from the point of view of a possible antiangiogenic effect in a model of primary nasal polyp (NP) tissue culture. Methods: NP samples of 21 patients and normal healthy nasal mucosa samples of 7 patients were cultured. Samples were divided into four groups as follows (healthy nasal mucosa, NP without any treatment, NP treated with propranolol, NP treated with bevacizumab). Cultured tissues were formalin fixed and paraffin embedded. Tissue sections and immunohistochemical VEGF-A, angiopoietin-1 (Ang-1), and angiopoietin-2 (Ang-2) expressions were evaluated. ELISA was also performed for each one of them. Results: Both propranolol and bevacizumab significantly decreased the expressions of VEGF-A and Ang-1, and they significantly increased the expression of Ang-2 in comparison to the control NP group. In the healthy nasal mucosa group, no significant expression of VEGF-A was seen, a slight (+) Ang-1 expression, and a high (+++) Ang-2 expression were observed. Conclusion: Bevacizumab and propranolol exert an antiangiogenic effect on NP tissues, mainly by decreasing VEGF-A and Ang-1 expression, increasing Ang-2 expression.

Oleuropein Effect on Noise-Induced Hearing Loss.

BACKGROUND: To investigate the possible protective activity of oleuropein compound on noise-induced hearing loss in rats. METHODS: Twenty-eight adult male albino rats were divided into 4 groups. Control normal saline (n=7) group was kept noise-free. Control oleuropein group (n=7) group was kept noise-free and was administered with 50 mg/kg/day oleuropein. The experimental normal saline (n=7) group was subjected to noise. The experimental oleuropein (n=7) group was subjected to noise and was administered with 50 mg/kg/day oleuropein. The experimental groups were subjected to 4 kHz octave noise with a frequency of 120 dB Sound Pressure Level (SPL) for 4 hours. Hearing level measurements were performed with auditory brainstem response and distortion-product otoacoustic emission tests before and after the 1st, 7th, and 10th day of the noise exposure. On the 10th day, rats were sacrificed. The temporal bones of the rats were removed and the cochlea and spiral ganglion cells were evaluated using hematoxylin-eosin staining under light microscopy. RESULTS: Better hearing thresholds were achieved in the experimental oleuropein group compared to the experimental normal saline group at 8 kHz, 12 kHz, 16 kHz, and 32 kHz frequencies (P < .05). Although no statistically significant difference was found between the groups, in the experimental normal saline group, the percentage of damaged spiral ganglion cells was higher than the experimental oleuropein group. CONCLUSION: Our findings suggest that oleuropein may have a partial protective effect against noise-related hearing loss. However, further research with higher doses is needed to justify this protective effect.

Dexamethasone-loaded chitosan-based genipin-cross-linked hydrogel for prevention of cisplatin induced ototoxicity in Guinea pig model.

OBJECTIVES: The aim of this study was to investigate the protective effects of a sustained release form of dexamethasone (dex) loaded chitosan-based genipin-cross-linked hydrogel (CBGCH) in a guinea pig model of cisplatin (CP) induced hearing loss. METHODS: Implantation of CBGCH was made by intratympanic (IT) injection. Ototoxicity was produced by intraperitoneal (IP) single dose of 14 mg/kg CP. Animals were randomly divided into four groups with 6 guinea pigs in each. Group 1 received only IP CP; group 2 received only IT dex-loaded CBGCH injections. Group 3 and group 4 received IP CP, plus IT nondrug CBGCH and IT dex-loaded CBGCH respectively 24 h prior to IP CP injections. Distortion product otoacoustic emissions (DPOAEs) and auditory brainstem response (ABR) measurements were obtained before the treatments and solely ABR measurements were done after 3 and 10 days. The ultrastructural effects were investigated by scanning electron microscopy (SEM) analysis. RESULTS: The postCP ABR thresholds at 4, 8, 12, 16, 32 kHz frequencies were significantly better in group 4 than groups 1 and 3 (p < 0.05). The comparison of time effective ABR thresholds between groups 1 and 4 and between groups 3 and 4 showed significantly lower ABR thresholds in group 4 (p < 0.05). The SEM analysis showed that stereocilia of inner and outer hair cells were preserved in group 4, almost like group 2, whereas cytotoxic degenerations were noted in groups 1 and 3. CONCLUSIONS: Intratympanic administration of dex-loaded CBGCH has been shown to provide functional and structural protection against CP-induced ototoxicity.

Turkish validation of the Sino-Nasal Outcome Test-22.

OBJECTIVES: The Sino-Nasal Outcome Test (SNOT)-22 is a widely used health-related quality of life questionnaire. This study aimed to conduct a translation and validation study of the SNOT-22 in the Turkish language. DESIGN: We achieved a convenient translation and cultural adaptation process to translate the original SNOT-22 into the Turkish language (observational prospective cohort study). SETTING: This study was conducted in a single tertiary-level university hospital. PARTICIPANTS: We performed reliability, validity and responsiveness analyses in 313 participants. One hundred eighty-nine of the participants were the chronic rhinosinusitis (CRS) group, and 79 healthy volunteers enrolled in the control group. Twenty-nine participants who underwent endoscopic sinus surgery for CRS were evaluated for pre-postoperative responsiveness analysis. MAIN OUTCOME MEASURES: Reliability (internal consistency and test-retest reproducibility), validity, responsiveness, sensitivity and specificity. RESULTS: The internal consistency coefficient (Cronbach's alpha) was 0.909 in the CRS test group, 0.955 in the CRS retest group, and 0.916 in the control group. The reliability value (Pearson correlation coefficient) of the test-retest group was 0.901. The validity was assessed by the independent sample t-test between the CRS and control groups and resulted in a significant difference (P < 0.001). Responsiveness was interpreted using the paired t-test between pre- and post-medical and pre- and post-surgical treatment groups; statistical analysis found significance in both groups (P < 0.001). When using the SNOT-22 cut-off value of 33.5, the sensitivity and specificity of the Turkish version of the SNOT-22 was 54.5% and 75.9%, respectively (95% CI, area under the curve (AUC): 0.69, range 0.624â€"0.756, P = 0.000). CONCLUSIONS: The authors suggest that the Turkish SNOT-22 is a valid, reliable, reproducible and responsive questionnaire.

Computed Tomographic Analysis: The Effects of Frontal Recess Morphology and the Presence of Anatomical Variations on Frontal Sinus Pneumatization.

The aim of this study is to describe the morphology of frontal recess area with its anatomical variations and to reveal if frontal recess morphology and the anatomical variations related to that region have effects on the pneumatization of the frontal sinuses. The frontal sinus and recess morphometry of 136 sides of 68 dry skulls were evaluated on multislice high-resolution computed tomography. The relationships between frontal sinus and frontal recess measurements were analyzed by correlation and linear regression analysis. The variables between the groups of anatomical variations were analyzed by Mann-Whitney U test and χ test or Fisher exact test. A positive relationship between the sagittal length of spina nasalis interna and morphometric measurements of frontal sinus was revealed (P <0.05). Agger nasi cells were present in 64.2% of sides, supraorbital ethmoid cells (SOECs) in 19.6%, type 3 frontal cells (FCs) in 18.9%, suprabullar cells in 24.3%, and frontal bulla was noted in 5.4%. Intersinus septal cells were observed in 16.2% of the skulls. There were statistically different increases in the measurements of frontal sinus morphometry in the presences of SOECs and type 3 FCs (P <0.05). The diameter of frontal sinus ostium was decreased in the presences of AN, SOEC, type 3 FC, and supraorbital ethmoid cell statistically (P = 0.049, P = 0.029, P = 0.043, P <0.001 respectively). In conclusion, frontal sinus pneumatization was affected by the spina nasalis interna and the presence of anatomical variations related to frontal recess or ostium region instead of the morphology of that area.

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.

The classification of frontal sinus pneumatization patterns by CT-based volumetry.

PURPOSE: We aimed to define the classification of frontal sinus pneumatization patterns according to three-dimensional volume measurements. METHODS: Datasets of 148 sides of 74 dry skulls were generated by the computerized tomography-based volumetry to measure frontal sinus volumes. The cutoff points for frontal sinus hypoplasia and hyperplasia were tested by ROC curve analysis and the validity of the diagnostic points was measured. RESULTS: The overall frequencies were 4.1, 14.2, 37.2 and 44.5 % for frontal sinus aplasia, hypoplasia, medium size and hyperplasia, respectively. The aplasia was bilateral in all three skulls. Hypoplasia was seen 76 % at the right side and hyperplasia was seen 56 % at the left side. The cutoff points for diagnosing frontal sinus hypoplasia and hyperplasia were '1131.25 mm(3)' (95.2 % sensitivity and 100 % specificity) and '3328.50 mm(3)' (88 % sensitivity and 86 % specificity), respectively. CONCLUSIONS: The findings provided in the present study, which define frontal sinus pneumatization patterns by CT-based volumetry, proved that two opposite sides of the frontal sinuses are asymmetric and three-dimensional classification should be developed by CT-based volumetry, because two-dimensional evaluations lack depth measurement.

Effect of steroids for nasal polyposis surgery: A placebo-controlled, randomized, double-blind study.

OBJECTIVES/HYPOTHESIS: Although medical intervention is the first option for treatment of nasal polyps, surgery is still a therapeutic option for symptomatic cases that do not respond or partially respond to medical intervention. However, there is a need for high-level evidence for the preoperative use of steroids in nasal polyposis surgery. We aimed to assess the perioperative effect of preoperative use of oral prednisolone for advanced-stage diffuse nasal polyposis. STUDY DESIGN: Prospective, double-blind, randomized, placebo-controlled study. METHODS: A visual analog scale (VAS) was evaluated for smell, nasal discharge, nasal obstruction, facial pressure, headache, butanol smell threshold, and peak nasal inspiratory flow (PNIF) before and after the use of study drug. Perioperative bleeding volume, visibility of operative field, operative time, hospital stay, and complication rate were also evaluated. RESULTS: The improvement in the corticosteroid group (CG) in the VAS scores, butanol thresholds, and PNIF values showed statistically significant differences compared to the placebo group (PG) (P < .05). The perioperative bleeding volume, visibility score, operative time, and hospital stay for CG/PG were 141 mL/384 mL, 2.4/3.4, 61 min/71.6 min, and 1.1 day/1.8 day, respectively (P < .05). The difference between the complication rates for the two groups did not show any statistically significant difference (P = .214). CONCLUSIONS: Preoperative administration of systemic corticosteroids improves the perioperative visibility by reducing blood loss and shortens the operation time. We recommend the use of preoperative corticosteroid for the safety of the patients. The optimum dose and duration have not been established and require further studies. LEVEL OF EVIDENCE: 1b.

Sphenovomerine suture: a useful landmark for locating sphenoid sinus ostium.

AIM: The aim of this study was to determine whether the sphenovomerine suture (SVS) can be used as a landmark to localize the sphenoidal sinus ostium. METHODS: Endoscopic imaging was done on 152 skulls to identify ostium of the sphenoidal sinus, the SVS, and the articulation of sphenoidal process of palatine bone between the body of the sphenoid and the sphenopalatine foramen. The variables were as follows: (1) the distance between the medial border of the ostium and SVS (DSO-SVS); (2) the angle between them (ASO-SVS); (3) the distance between the inferior border of the ostium and the horizontal line (DSO-HL); (4) the distance between intersection point of the SVS-sphenoidal process of the palatine bone and the medial border of sphenopalatine foramen (DSPF-SVS); and (5) the number of sphenopalatine foramen. RESULTS: Of the 152 skulls, 289 sides were included in the study. The mean value for DSO-SVS was 3.15 (1.35) mm, DSO-HL was 5.99 (2.38) mm, DSPF-SVS was 7.07 (1.96) mm, and ASO-SVS was 5.99 (9.73) mm. As DSPF-SVS decreases, DSO-SVS and DSO-HL decrease with statistical significance (Ps = 0.02 and 0.001, respectively). The distribution of the numbers of sphenopalatine foramen was as follows: one 90%, two 9.7%, and four 0.3%. CONCLUSIONS: The horizontal distance between the SVS and the sphenopalatine foramen plays a significant role in identifying the location of sphenoid sinus ostium. As with the other landmarks, the SVS provides an additional benefit in locating the sphenoid sinus ostium for endoscopic sinus surgeons. The incidence of 4 sphenopalatine foramen is 0.3%.

Epistaxis management: is medical intervention required for inactive epistaxis?

OBJECTIVES: This study aims to discuss the management and the follow-up approach in patients with epistaxis. PATIENTS AND METHODS: A total of 367 patients with epistaxis (209 males, 158 females; mean age 52.6±18.3 years; range 18 to 85 years) admitted to the Adult Emergency Department of a university hospital between January 2000 and December 2004 were retrospectively analyzed. RESULTS: Of patients, 56.7% had an idiopathic bleeding. A significantly higher number of patients aged >50 years had high blood pressure on admission. Of 141 patients (38.49%) presenting without bleeding on admission, 20 required medical intervention for recurrent epistaxis. Conservative approaches were effective in stopping bleeding in 97.8% patients. The hospitalization ratio was 5.7%. CONCLUSION: Our study result show that endonasal endoscopic mucosal cauterization is an effective method for resistant-to-treatment cases and inactive bleeding on admission is not a restraint for further examination.

Otoprotective effect of recombinant erythropoietin in a model of newborn hypoxic-ischemic encephalopathy.

OBJECTIVE: The aim of this study is to test the hypotheses that central auditory pathology as well as inner ear pathology is contributing mechanisms to observed hypoxic-ischemic encephalopathy (HIE) induced hearing loss and that recombinant erythropoietin (rhEPO) will reduce this cellular pathology and attenuate hearing loss. METHODS: Twenty-eight 7-day Wistar albino rat pups were divided into four groups: Control group (n=8) was given only intraperitoneal saline solution. Sham group (n=5) had only a midline neck incisions without carotid ligation under general anesthesia and administration of intraperitoneal saline solution. HIE group (n=8) and rhEPO treated group (n=7) were subjected to left common carotid artery ligation followed by 2.5h hypoxia exposure to a mixture of 8% oxygen and 92% pure nitrogen. HIE group was injected with intraperitoneal saline solution, while the rhEPO treated group received rhEPO 100 U/kg within the same volume as the saline-alone solution. At the end of the seventh week of age hearing (ABRs) was evaluated in response to clicks, 6 kHz and 8 kHz tone burst stimuli. Animals were sacrificed and both temporal lobes, cochleas and brainstems of the animals were collected. Tissue samples were evaluated with light microscopy, immunohistochemical studies, including TUNEL and caspase-3 stainings, and electron microscopy. RESULTS: Hearing thresholds were elevated in HIE animals. In rhEPO treated animals, ABR values were similar to controls. HIE caused apoptotic changes in brainstem structures as shown by light microscopy and immunohistochemical methods. Apoptotic changes also were found within the organ of Corti, spiral ganglion cells and neurons of temporal lobe by electron microscopic investigation. In rhEPO animals many of these apoptotic changes were observed, but reduced compared to untreated animals. CONCLUSIONS: Mechanisms underlying HIE-induced hearing loss are based on apoptosis in inner ear; however central auditory pathway pathology occurs as well, likely contributing to changes in auditory processing and perception of complex signals not reflected by the ABR threshold shifts. For both clinical and basic significance 'rhRPO' is found to reduce those effects.

Microdebrider assisted endoscopic marsupialization of congenital intranasal nasolacrimal duct cysts.

OBJECTIVE: To provide information on the clinical characteristics and management of an uncommon congenital nasolacrimal system anomaly, intranasal nasolacrimal duct cyst. METHODS: Three patients treated with microdebrider assisted endoscopic marsupialization for intranasal nasolacrimal duct cysts were included in this study. Management and outcomes are compared to previous reports in the literature. RESULTS: Patients were presented in between 2007 and 2010. Diagnosis was made by clinical observation and endoscopic nasal examination. The first patient is a 1 year old child with congenital dacryocystocele presented as a right medial canthal mass and ipsilateral intranasal cyst. The second patient is a 60 days old child presented with nasal obstruction and feeding difficulty who was found to have bilateral intranasal cystic masses. The third patient was a 6 days old newborn with respiratory distress, whose nasal endoscopy revealed bilateral choanal atresia and left side intranasal cyst. All three cases were treated with nasal endoscopic marsupialization and no recurrence of symptoms and physical findings were found. CONCLUSIONS: Intranasal nasolacrimal duct cysts may lead to nasal obstruction, respiratory distress and feeding difficulty. An otorhinolaryngologist should be consulted, as nasal endoscopy is fundamental for diagnosis. Microdebrider assisted endoscopic marsupialization is a safe and curative treatment.

[Evaluation, diagnosis and treatment criteria for bacterial rhinosinusitis among primary health care physicians]. / Birinci basamak hekimleri arasinda akut bakteriyel rinosinüzit degerlendirme, tani ve tedavi ölçütleri.

OBJECTIVES: This study was planned to determine the evaluation criteria for acute bacterial rhinosinusitis (ABRS) among primary health care physicians. PATIENTS AND METHODS: This study was conducted with face-to-face survey method between April 2009 and June 2009. The physicians were asked to answer the prespecified questions about the etiopathogenesis, diagnosis and treatment criteria for ABRS by grading from 1 to 5. The demographic and undergraduate education information of the physicians, daily number of patients they see, the number of patients diagnosed with ABRS and family physicians specialization were asked. One hundred and forty two physicians visits were performed at 33 Health Centers or Public Health Centers. Sixty-nine doctors (34 males, 35 females; mean age 44.5±5.5 years; range 33 to 57 years) answered the survey. RESULTS: Medical experience was 20.0±5.5 years and 52.2% of the physicians were Family Physicians and 47.8% were General Practitioners. For diagnosis, the history (87.3%) and Waters X-ray (74.6%) were reported as the most utilized tools. Among antibiotics, amox-clu, cefuroxime axetil and levofloxacin were found to be preferred at rates of 80.9%, 76.1% and 60.3%, respectively. 74.6% and 96.8% of the physicians lacked the facility to perform radiological examination and culture, respectively. CONCLUSION: 48.6% of the visited physicians agreed to answer the questionnaire. According to the results of the survey, General Practitioners and Family Physicians involved in conducting the basic health services did not assimilate criteria for diagnosis and treatment of ABRS. Training targeting ABRS should be involved for postgraduate period.

Cartilage tympanoplasty: indications, techniques, and results.

OBJECTIVE: To present our experience with cartilage grafts in ear surgery and review the indications and techniques. DESIGN: Retrospective clinical evaluation. SETTING: There were 25 ears of 23 patients in our series, with a mean follow-up of 24.7 months (range 12-53). METHODS: The surgeries were eight type I tympanoplasties, four type III tympanoplasties without mastoidectomy, and four canal wall up and nine canal wall down tympanomastoidectomies with ossicular reconstruction. Nine total ossicular replacement prostheses and eight partial ossicular replacement prostheses were used in the ossicular reconstructions. Fourteen cartilage grafts were harvested from the concha and 11 from the tragus; the grafting technique was total cartilage plate in 18 ears, cartilage shield in 6 ears, and palisade in 1 ear. MAIN OUTCOME MEASURES: Otomicroscopic, otoendoscopic, and audiologic examinations before and after the surgeries. RESULTS: There were no cases of graft loss, and no perforations were observed. The postoperative hearing was stable in 9 ears (36%) and improved in 16 ears (64%), with a mean postoperative hearing gain of 20 dB (range 10-40 dB). We concluded that cartilage grafts are ideal in cases of retraction and adhesion, as well as sclerosis, atrophy, and infection. CONCLUSIONS: Cartilage can be used as a total, shield, or palisade graft in ear surgery. These grafts are stable and reliable, and the postoperative hearing results are as good as or even better than fascia grafting.

The microdébrider and its complications in endoscopic surgery for nasal polyposis.

OBJECTIVE: The aim of this study was to assess the rate of complications of the microdébrider in endoscopic sinus surgery (ESS) for nasal polyposis. STUDY DESIGN AND SETTING: A retrospective study was done on the complications occurring during ESS for nasal polyposis and chronic rhinosinusitis (CRS) without nasal polyps in which a microdébrider had been used on 275 sides of 139 patients in a tertiary university practice setting. RESULTS: The mean sinus opacification scores in computed tomography, according to the Lund-Mackay staging system, were 9.2 +/- 2.28 for the nasal polyposis group and 4.8 +/- 1.54 for the CRS group. There was one major complication, a cerebrospinal fistula that was repaired during the surgery. The minor and major complication rates for the nasal polyposis group were 11.8% and 0.5%, respectively. The minor complication rate for the CRS group was 4%. CONCLUSION: Knowledge of endonasal anatomy, surgical experience, a bloodless operating field, and being careful about every colour change during the operation are the fundamental essentials for lowering the complication rate. With its lower incidence of complications, even in high-risk cases such as nasal polyposis, a microdébrider provides acceptable complication rates in ESS. Also, the severity of the disease is the main determining factor for the final complication rate.

Diagnostic contribution of virtual endoscopy in diseases of the upper airways.

PURPOSE: Virtual endoscopy (VE) is a new diagnostic tool that generates 3-dimensional (3D) views of a lumen by exploiting cross-sectional images. The purpose of this study was to evaluate the usefulness of VE as a diagnostic tool in the diseases of the larynx and pharynx. MATERIALS AND METHODS: Twenty-two patients with a mean age of 57 years were included in the study. The patients underwent larynx examination, optical endoscopy (OE), and computed tomography (CT) of the larynx. Later, VE was produced from the CT images. RESULTS: Eight patients had larynx carcinoma, a 5-year-old patient had a laryngeal web, a 43-year-old man had fish bone stuck in his submucosal layer, 10 patients were normal, and the remaining two patients were under follow-up for treated nasopharynx carcinoma and had no evidence for recurrence. VE showed the laryngeal tumor in seven patients and the laryngeal web in one patient, but failed to show a plaquelike tumor and the fishbone within the submucosa. CONCLUSIONS: Our findings suggest that VE is a useful and complimentary method of 3D imaging in the diseases compromising the laryngeal lumen. Furthermore, it may be superior to OE in severe stenosis or obstructions where the endoscope cannot be passed through.

Plexiform neurofibroma of the tongue: a case report of a child.

A three-year-old girl with a lingual plexiform neurofibroma treated by total excision is presented. Despite their occurrence in the head and neck region, neural sheath tumors are rarely encountered in the oral cavity. It is reported that 4-7% of patients affected by neurofibromatosis display oral manifestations. Neurofibromatosis is characterized by café-au-lait spots and cutaneous neurofibromas. Plexiform neurofibroma is said to be indicative of von Recklinghausen's disease (VRD) even though it may be the only manifestation of the disease. Generally, surgical resection represents the treatment of choice and the diagnosis can only be confirmed after histological examination. Affected patients need regular follow-up to detect malignant degeneration, an early recurrence or appearance of other manifestations of VRD.

Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary?

OBJECTIVE: To evaluate the necessity of histopathologic examination for routine tonsillectomy and/or adenoidectomy in terms of unexpected malignancy by evaluating a large group of pediatric patients retrospectively with review of the literature. MATERIALS AND METHODS: A retrospective chart review of all patients under the age of 19 who underwent tonsillectomy and/or adenoidectomy between January 1990 and January 2005 was carried out. The records were analyzed concerning each patient's age, sex, indication for surgery, type of surgical procedure and the result of histopathologic examination of the specimen. The patients operated for chronic or recurrent infections and obstructive hypertrophy were included in the study. Moreover, the English literature was searched in Medline for articles published between 1949 and March 2005 and the studies dealing with pathologic analysis of tonsillectomy and/or adenoidectomy specimens were reviewed. RESULTS: The total number of patients was 2826. After excluding 83 patients because of insufficient data, 2743 patients with an age distribution from 1 to 18 years (mean: 7.53) were reviewed. There were 1534 males (56%) and 1209 females (44%). Tonsillectomy and adenoidectomy were performed together on 1930 patients (70%) while tonsillectomy and adenoidectomy alone were performed on 287 (10%) and 526 (20%) patients, respectively. Evaluation of the pathology reports revealed no malignancies. Review of the literature identified 14 articles and 5 of them included only pediatric patients. The rate of unexpected malignancies observed in these pediatric series varied between 0 and 0.18%. CONCLUSION: After being evaluated by an experienced otolaryngologist, pathologic evaluation of all specimens may not be necessary if a child undergoing routine tonsillectomy and/or adenoidectomy is not found to have certain preoperative risk factors.