Short-term evaluation of over-under myringoplasty technique.

Over-under tympanoplasty is a technique aimed at eliminating the disadvantages of the two classical techniques of overlay and underlay myringoplasty, which are employed in repairing the tympanic membrane. In this retrospective study, a total of 104 patients underwent myringoplasty, which was performed by means of the underlay technique in 46 patients and over-under technique in 58 patients. The mean follow-up period was 11 months. In the first group of patients, the underlay technique was performed; the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the second group, the over-under technique was performed; the grafted membrane was placed under the remaining drum and over the malleus. The rate of success in the first group of 46 patients was 91.5%, and that of atelectasis was 19.5%. The rate of success in the second group of 58 patients was 94.9% and 12%, respectively. Lateralization of the graft was not observed in either of the groups. In the patients operated on by means of the underlay technique, the air-bone gap decreased by 16.55 dB this rate was 16.96 dB in those operated on by the over-under technique. The authors consider over-under tympanoplasty to be superior to the other two classical methods not only because of its effectiveness, but also because of the results achieved by this technique.

Isolated laryngeal lymphangioma showing the symptoms of acute epiglottitis.

Lymphangiomas are rare, congenital lesions of the lymphatic system, and about 90% of them are detected by the 2nd year of life. Although the head and neck region is the most common place of presentation, isolated laryngeal lymphangioma is extremely rare. A 37-year-old female patient presented with characteristic symptoms of acute epiglottitis. After her acute symptoms resolved with medical treatment, endoscopy was performed, and a wide, pedunculated mass arising from the epiglottis of the larynx was seen. The mass was totally excised and microscopically diagnosed as lymphangioma. To our knowledge, this is the first such case reported in the literature. In the control examination performed after 9 months, no evidence of recurrence was revealed. This interesting case illustrates that the symptoms of acute epiglottitis in the adult should be further investigated to exclude rare lesions such as lymphangioma.

Should hyperbaric oxygen be added to treatment in idiopathic sudden sensorineural hearing loss?

At present, there is still no agreement about the therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Hyperbaric oxygen (HBO) is used in the therapy of ISSHL to increase the partial oxygen pressure and the oxygen concentration in the inner ear and also to improve the blood profile and the microcirculation. In our prospective randomized study, we aimed to investigate the therapeutic effects of HBO therapy in the 1st 2 weeks of the onset of ISSHL. Fifty-one hospitalized patients with confirmed ISSHL who had received therapy were grouped randomly into two groups. Twenty-one patients (group I) received steroids, plasma expander dextrans (rheomacrodex), diazepam, pentoxiphylline and salt restriction, and 30 patients (group II) received the same basic treatment with the addition of HBO therapy. Audiological assessments of the patients were performed before and after the treatment. The hearing gains at frequencies of 250, 500, 1,000, 2,000 and 4,000 Hz were calculated separately. The level of hearing loss at the five frequencies was assessed in three groups at the first visit: equal or below 60 dB, between 61-80 dB and equal or above 81 dB. The average of the mean hearing gains at the five frequencies of the patients according to the age groups in group II was compared. The mean hearing gains at the five frequencies were compared between the two groups, and statistically significant improvement was detected in all the frequencies except at 2,000 Hz in group II. The mean hearing gains in group II were found to be significantly high in patients with initial hearing levels up to 60 dB in comparison to patients with initial hearing levels below 60 dB. When age groups and mean hearing gains were compared, there was no statistically significant difference in group I. In group II, the mean hearing gains were 39.1+/-18.3 dB in patients younger than 50 years and 22.7+/-11.3 dB in patients older than 50 years ( P=0.044). In conclusion, the addition of HBO therapy to conventional treatment modalities significantly improves the outcome of ISSHL, especially at the frequencies of 250, 500, 1,000 and 4,000 Hz and in hearing loss of above 61 dB. Furthermore, HBO therapy was found to be more effective in patients younger than 50 years.

[The effect of laryngectomy and postoperative radiotheraphy on thyroid gland functions]. / Larenjektomi ve izleyen radyoterapinin tiroit fonksiyonlari üzerine etkisi.

OBJECTIVES: We investigated the frequency of hypothyroidism in patients treated with total laryngectomy, hemithyroidectomy-isthmectomy, and postoperative radiotherapy for T3 or T4 larynx cancers. PATIENTS AND METHODS: Twenty-nine male patients (mean age 54 years; range 43 to 72 years) with T3 or T4 larynx cancers were prospectively included in the study. Preoperatively, thyroid function tests were normal in all the patients. Following radiotherapy, serum thyroid-stimulating hormone (sTSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured every three months at least for a year. Detection of an increased level of sTSH together with decreased or normal levels of FT3 and/or FT4 indicated clinical and subclinical hypothyroidism, respectively. The relationship was assessed between hypothyroidism and both age and radiotherapy dosage. Statistical analyses were made with the use of the Student's t- test and Mann-Whitney U-test. RESULTS: Following radiotherapy, thyroid function tests remained normal in 12 patients (41%), while 12 patients (41%) and five patients (18%) developed subclinical and clinical hypothyroidism, respectively. No significant relationship was found between age and thyroid dysfunction (p>0.05), whereas radiotherapy dosage was found in significant relationship with the development of hypothyroidism (p<0.05). CONCLUSION: Due to high rates of subclinical or clinical hypothyroidism following combined therapy, thyroid functions should be closely monitored in patients undergoing laryngectomy for T3 or T4 larynx cancers.

[The relationship between the presence of Candida colonization in the oropharynx and on the Blom-Singer voice prosthesis and its effect on the length of prosthesis use]. / Orofarenkste ve Blom-Singer ses protezi üzerinde üreyen Candida kolonizasyonu arasindaki iliski ve bunun protez ömrü üzerine etkisi.

OBJECTIVES: We investigated the effect of oropharyngeal Candida colonization on the contamination of the Blom-Singer voice prosthesis and its lifetime. PATIENTS AND METHODS: The study included 26 male laryngectomized patients (age range 45 to 76 years) in whom the Blom-Singer low-pressure prosthetic valve inserted required removal due to improper functioning. All patients had postoperative radiotherapy. Patients who had nystatin therapy were excluded. At the time of removal, cultures were obtained from the esophageal end of the prosthesis and from the oropharynx to be examined with regard to Candida growth. RESULTS: Candida colonization was recovered from the cultures obtained on 20 prostheses (77%) and from 14 oropharyngeal specimens (54%). The presence of oropharyngeal colonization was always associated with that on prostheses. The average lengths of prosthesis use were 5.7 months (range 4 to 9 months) and 6.2 months (range 3 to 10 months) in patients with and without positive oropharyngeal Candida colonization, respectively (p>0.05). CONCLUSION: The results suggest that the presence of oropharyngeal Candida colonization has no effect on the prosthesis lifetime.

[The effect of nasal packing with or without an airway on arterial blood gases during sleep]. / Hava yolu içeren ve içermeyen burun tamponlarinin uyku sirasinda arteryel kan gazlari üzerine etkisi.

OBJECTIVES: We investigated the effect of postoperatively applied nasal packing with or without an airway on partial arterial oxygen (PaO(2)) and carbon dioxide (PaCO(2)) pressures during sleep. PATIENTS AND METHODS: The study included 40 patients (24 men, 16 women; mean age 29 years; range 18 to 60 years) who underwent septoplasty operation. The patients were randomly assigned to postoperative nasal packings with (n=20) or without (n=20) an airway. PaO(2) and PaCO(2) levels were measured during sleep on the preoperative night and on the postoperative first and second nights. The findings were compared. RESULTS: No significant differences were found between the preoperative and postoperative PaO(2) and PaCO(2) levels obtained with nasal packing containing an airway. However, the mean PaO(2) level measured on the postoperative second night significantly decreased in patients wearing a nasal packing without an airway, when compared with the mean preoperative value and with that obtained from the other group on the same night (p<0.05). On the other hand, increases in the mean PaCO(2) levels did not reach significance. In both groups, postoperative PaO(2) and PaCO(2) values were within acceptable limits. No signs of hypoxia or hypercapnia were detected. CONCLUSION: To prevent decreases in the PaO(2) levels, the use of nasal packings with an airway seems to be more appropriate in patients susceptible to hypoxia.

[Comparison of palpation, ultrasound and computed tomography in the valuation of lymphatic neck metastasis]. / Boyun metastazlarinin gösterilmesinde palpasyon, ultrasonografi ve bilgisayarli tomografinin karsilastirilmasi.

OBJECTIVES: We evaluated the diagnostic value of palpation, ultrasonography (US), and computed tomography (CT) in detecting neck metastasis in head and neck cancers. PATIENTS AND METHODS: The study included 35 patients (34 men, 1 woman; mean age 59 years; range 35 to 72 years) with laryngeal carcinoma. In addition to neck palpation, 17 patients and 27 patients had neck examinations by US and CT, respectively. Histopathologic results of the neck specimens were compared with those obtained from palpation, US, and CT. RESULTS: The accuracy of CT, US, and palpation in the evaluation of lymph nodes of the neck were 85%, 65%, and 80%, respectively. Ultrasonography was found to have the highest sensitivity (100%), but the least specificity (33%). The highest false positive and false negative results were obtained by US (42%) and palpation (10%), respectively. CONCLUSION: Computed tomography proved superior to palpation and US in the evaluation of neck metastasis in patients with head and neck tumors.