The Management of the Paranasal Sinus Osteomas.

OBJECTIVE: Osteoma is the most common benign tumor of the paranasal sinuses. The clinical characteristics and treatment of this disease remain controversial. The aim of this study is to determine the appropriate method of treatment approach according to the features of osteomas. METHODS: Forty-one patients with paranasal sinus osteomas were included in the study. According to the location and the size of tumors, patients were followed up or operated. Surgical treatment was performed via external, endoscopic, or combined approaches for symptomatic patients. Routine physical and radiological evaluations were performed for follow-up in asymptomatic patients. RESULTS: Paranasal sinus osteomas were found most common in frontal sinus (n = 26, 63.4%) followed by ethmoid sinus (n = 10, 24.3%), maxillary sinus (n = 4, 9.7%), and sphenoid sinus (n = 1, 2.4%). Of the patients with frontal sinus osteomas, the endoscopic approach was performed in 11 patients, external approach (osteoplastic flap) in 9, and combined (external + endoscopic) approach in 5 patients. Endoscopic approach was preferred in all patients with ethmoid osteoma. The combination of Caldwell-Luc procedure and endoscopic approach was performed in 1 patient with maxillary sinus osteoma. In 3 patients, who underwent osteoplastic flap technique, mucocele developed in the postoperative period. Partial loss of vision developed postoperatively in 1 patient with a giant ethmoid osteoma. There were no other complications and recurrence in an average of 29 months follow-up. CONCLUSION: Paranasal sinus osteomas are rare, slow-growing benign lesions, with potentially serious complications. Main treatment option for sphenoid and ethmoid sinus and other symptomatic osteomas are surgical resection. Radiographic follow-up is necessary for asymptomatic lesions. Selection of surgical resection method depends on tumor location and size. Patients should be observed for recurrence with periodic examination and imaging techniques. Follow-up should be performed at least in 1-year intervals after the surgery. LEVEL OF EVIDENCE: 1c.

Changes in Proinflammatory Cytokines in the Cochlea in Relation to Hearing Thresholds in Noise-Exposed Rats.

OBJECTIVE: Our aim was to investigate time effects in proinflammatory cytokines and the auditory brainstem response (ABR) thresholds of rat cochlea exposed to noise. MATERIALS AND METHODS: Twenty-one rats were divided into two groups: the control group and the noise group. As high as 115 dB sound pressure of white noise was administered to the noise group of 16 rats for 3 h a day for 10 days. This group was further split into four subgroups based on the timing of sacrifice: 3rd hour group, 12th hour group, 24th hour group, and 28th day group. ABR thresholds were measured in all the rats, after the noise exposure and right before being sacrificed. Proinflammatory cytokine levels (IL-6, IL-1ß, and TNF-α) at the cochlea were measured. RESULTS: We found a significant difference between the first ABR thresholds (5 dB nHL) and the post-exposure ABR thresholds in each group (25 dBnHL, 35 dBnHL, 15 dBnHL, and 17.50 dBnHL for the 3rd hour group, 12th hour group, 24th hour group, and 28th day group, respectively). The IL-1ß levels in the 3rd hour group and 12th hour group were significantly higher than those in the control group and other noise subgroups. The TNF-α level in the 3rd hour group was significantly higher than that in the control group and other noise subgroups. CONCLUSION: It seems reasonable to point out a direct correlation between the cytokine levels and hearing threshold levels after the noise exposure. This correlation was the highest for IL-1ß. This result suggested a significant role of proinflammatory cytokines in hearing deterioration after noise exposure.

[Treatment approaches to temporal bone osteomas]. / Temporal kemik osteomlarinda tedavi yaklasimlari.

OBJECTIVES: This study aims to evaluate treatment approaches in relation to the localization, size and symptoms of temporal bone osteoma according to the complaints of the patient. PATIENTS AND METHODS: We retrospectively reviewed the records of 23 patients (16 males, 7 females; mean age 28.6 years; range 14-69 years) followed up with the diagnosis of temporal bone osteoma at our clinic between January 2005 and April 2016. We obtained the demographic features, clinical presentations (symptoms, location and size of the tumors), treatment approaches and postoperative outcomes of the patients from patients file. Treatment approaches were analyzed according to the characteristics of patients and of the tumor. RESULTS: The most common localization of osteomas was external auditory canal (66%), followed by mastoid bone (21%) and middle ear cavity (13%). The osteoma was detected incidentally in five patients out of 23. Treatment approaches were determined according to the presence of symptoms, size and localization of tumors. CONCLUSION: Physical examination and periodic follow-up is recommended in asymptomatic patients. In symptomatic patients, surgical resection is needed with an appropriate surgical approach based on the location and size of the tumor.

Life Priorities in Head and Neck Cancer Patients Between Ages of 45 to 65.

Diseases in head and neck cancer patients and applied therapies according to former affect life quality to a higher extent. In this paper, life priorities in 49 patients with head and neck cancer who referred to Gulhane Military Medical Academy for diagnostic and therapeutic purposes and the relationship between these priorities and sociodemographic properties have been studied. Following life priorities have been observed more important for the patients: to communicate with people in social places, to eat without any help by themselves, external appearance, taste and odor sense, continuing sexual life. Other priorities have been observed less important for the patients: attending social activities like cinema and theater, swimming pool and sea sports, money required for check-ups, necessities like time. Besides, these necessities do not show dissimilarities to any significant extent according to sociodemographic properties of the patients.

Increased frequency of mitral valve prolapse in patients with deviated nasal septum.

Any abnormality of collagen may affect the tissues with higher collagen content, e.g., joints, heart valves, and great arteries. Mitral valve prolapse (MVP) is a characteristic of generalized collagen abnormality. Nasal septum (NS) is constituted by osseous and cartilaginous septums that are highly rich in collagen. We evaluated the co-existence of deviation of NS (DNS) in patients with MVP. We retrospectively evaluated the recordings of echocardiographic and nasal examinations of subjects with MVP and DNS. We analyzed the features of MVP and anatomical classification of DNS among subjects. Totally, 74 patients with DNS and 38 subjects with normal nasal passage were enrolled to the study. Presence of MVP was significantly higher in patients with DNS compared to normal subjects (63 vs 26%, p < 0.001). Prolapse of anterior, posterior and both leaflets was higher in patients with DNS. Thickness of anterior mitral leaflet was significantly increased in patients with DNS (3.57 ± 0.68 vs 4.59 ± 1.1 mm, p < 0.001) compared to normal subjects. Type I, II, and III, IV DNS were higher in frequency in patients with MVP while type V and VI were higher in normal subjects. DNS is highly co-existent with MVP and increased thickness of mitral anterior leaflet. Generalized abnormality of collagen which is the main component of mitral valves and nasal septum may be accounted for co-existence of MVP and DNS. Also co-existence of them may exaggerate the symptoms of patients with MVP due to limited airflow through the nasal passage.

Evaluation of the changes in the nasal cavity during the migraine attack.

OBJECTIVES: There are some subjective symptoms involving the nasal cavity such as nasal congestion during a migraine attack. In this study, we aimed to evaluate the possible changes occurring in the nasal cavity during headache in patients with migraine. MATERIALS AND METHODS: Patients with migraine were studied. The control group consisted of patients with tension-type headache. The severity of the headache and accompanying complaints were assessed using visual analog scale, and the nasal mucosa was assessed through anterior rhinoscopy and endoscopy. Resistance of the nasal cavity was evaluated through anterior rhinomanometry. Data obtained during the attack periods and attack-free periods were compared. RESULTS: Twenty-five patients with migraine and 15 patients with tension-type headache were enrolled. It was found that 19 patients (76%) of the group with migraine and 5 patients of the group with tension-type headache were experiencing nasal congestion during the attack and that the differences between the groups were statistically significant (P < 0.05). The average of total nasal resistance in the patients with migraine was 0.57 ± 0.60 kPa/L/sn during migraine attacks and 0.28 ± 0.14 kPa/L/sn during attack-free periods. The average of total nasal resistance in the patients with tension-type headache was 0.32 ± 0.14 kPa/L/sn during attack periods and 0.31 ± 0.20 kPa/L/sn during attack-free periods. In the group with migraine, the change of nasal resistance between during the attack and attack-free periods was found statistically significant, whereas there was no statistically significant difference in the group with tension-type headache. CONCLUSIONS: According to the results of this study, complaints regarding nasal obstruction and nasal airway resistance increase during migraine attacks. Cause-and-effect relationship between nasal obstruction and pain is not clear, and clinical trials are needed to determine the effect of nasal obstruction treatment (mucosal decongestion, etc) on the complaint of pain.

Validity of late-term electroneurography in Bell's palsy.

OBJECTIVE: To evaluate the validity of early (within 3 wk) and late-term (after 3 wk) electroneurography (ENoG) findings in Bell's palsy (BP) to predict the prognosis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Patients with peripheral facial paralysis with no identified cause. All patients were given the same treatment. INTERVENTION(S): House Brackmann (HB) grading and ENoG. MAIN OUTCOME MEASURES: The records of 38 patients with BP were retrospectively analyzed. This study included only those patients who had been followed up for at least 4 months on a regular basis or until complete recovery. ENoG was performed for orbicularis oculi and orbicularis oris muscles and degeneration ratio was calculated separately. Correlation between HB grading and ENoG findings, relationship between duration for maximum recovery and ENoG findings, and also initial HB grading and recovery rate were investigated. RESULTS: Complete recovery rate was significantly higher in patients with HB grades I to III at initial examination. A significant correlation was found between HB grading and degree of ENoG degeneration at the 7th and 14th days of FP. Patients with degeneration less than 80% for orbicularis oculi and less than 65% for orbicularis oris had significantly better and faster recovery than those with higher level of degeneration (p < 0.05). CONCLUSION: ENoG and HB grading during first to fourth weeks of BP are useful prognostic indicators. Serial ENoG examinations are recommended to predict the status of neural degeneration and the prognosis of the palsy. However, ENoG in late term may not be compatible with clinical facial function.

Diagnostic utility of Stenger test: reappraisal of its value.

OBJECTIVE: Nonorganic hearing loss (NOHL) is a lack of consistency in audiological testing. Although NOHL is relatively rare, it is important to identify suspicious patients. This study was designed to evaluate the effectiveness of Stenger test and acoustic reflexes test (ART) in the evaluation of patients with suspicious of unilateral NOHL. STUDY DESIGN: A prospective study Methods: In this study, 474 adult patients with suspicious unilateral profound or total hearing loss were included. Pure tone audiometry (PTA), speech audiometry, Stenger test, ART and click-evoked auditory brainstem response (ABR) measurements were performed. The sensitivity, specificity and predictive values of the Stenger test and ART for unilateral, profound to total NOHL were assessed by comparing these with the results of ABR. RESULTS: The sensitivity and specificity of the Stenger test in verifying unilateral, profound hearing loss were 99% and 57%, respectively. The positive and negative predictive values of the test were 88% and 97%, respectively. The sensitivity and specificity of the ART in verifying unilateral, profound hearing loss were 96% and 60% at 1000 Hz and 98% and 60% at 2000 Hz, respectively. The positive and negative predictive values of the ART were 50% and 97% at 1000 Hz, and 75% and 97% at 2000 Hz, respectively. CONCLUSION: The Stenger test and ART are widely used for the evaluation of unilateral or asymmetrical NOHL. In our opinion, these tests are significantly powerful. More difficult cases require ABR to verify nonorganic hearing loss and to exclude specific diagnoses that may imitate NOHL.

Nasalance scores for normal-speaking Turkish population.

OBJECTIVE: The aim of this study was to obtain normative nasalance scores for adult and children subjects speaking Turkish language and obtain a reference for normality when nasality is evaluated. METHODS: Mean nasalance scores were obtained from 35 normal-speaking children aged 7 to 13 years, and 125 adults aged 18 to 69 years during the repetition of 3 nasalance passages that were categorized according to the amount of nasal consonants (oral, oronasal, and nasal passages). The Nasometer (model 6400) was used to obtain nasalance scores for the 3 reading passages. RESULTS: Group mean ± SD nasalance scores of children for oral passage, oronasal passage, and nasal passage were 15.14 ± 4.81, 37.76 ± 4.42, and 49.23 ± 6.95, respectively. Nasalance scores for the adult group were 13.46 ± 6.26, 37.84 ± 6.13, and 50.28 ± 7.77, respectively. There were significant differences in mean nasalance scores for oral versus nasal materials both for children and adult groups. CONCLUSIONS: The present study provides normative nasalance scores for Turkish-speaking children and adults. The results indicated acceptable differentiation between oral and nasal materials.

Effects of hyperbaric oxygen and dexamethasone on proinflammatory cytokines of rat cochlea in noise-induced hearing loss.

HYPOTHESIS: To investigate effects of dexamethasone and hyperbaric oxygen therapy (HBOT) on proinflammatory cytokines and hearing levels in the noise-exposed cochlea of rats. BACKGROUND: There is an arising concern about negative effects of early initiation of HBOT on hearing in noise-induced hearing loss. Furthermore, effects of HBOT and dexamethasone on cochlear cytokines are not fully elucidated. METHODS: Twenty-six rats were divided into 3 groups: control, noise, and treatment groups. Five rats served as control group. White noise at 115 dB sound pressure level was applied to the noise group of 4 rats for 10 days. This group was assigned to a positive control group as it was equivalent to treatment groups. The treatment group of 17 rats underwent the same noise exposure, and then, they were divided into 3 groups based on treatment protocol: 5 and 6 rats received HBOT at the third hour and 24th hour after the noise, respectively, and 6 rats received dexamethasone. Auditory brain stem response threshold was measured in all groups before being assigned to the groups, after the noise exposure and right before being killed. Cytokine levels at the cochlear soft tissues were measured using enzyme-linked immunoassay. RESULTS: Final thresholds (10 dB and 5 dB nHL-normal hearing level) of HBOT-24th hour and dexamethasone groups were significantly better than that of untreated noise group (22.5 dB nHL) (p < 0.05). There was no significant difference between HBOT-24th hour group (10 dB nHL) and dexamethasone group (5 dB nHL) (p > 0.05). IL-6 and IL-1ß of HBOT-third hour group (2.30 ng/mg and 185.43 pg/mg) were significantly higher than those of the noise group (0.91 ng/mg and 131.40 pg/mg), dexamethasone group (1.19 ng/mg and 112.29 pg/mg) and HBOT-24th hour group (1.34 ng/mg and 106.69 pg/mg) (p < 0.05). There was no significant difference in IL-6 and IL-1ß of HBOT-24th hour group, dexamethasone group, noise group, and control group (p > 0.05). There was no significant difference in TNF-α of the 3 treatment groups, noise group, and control group (p > 0.05). CONCLUSION: The results showed that the most effective method in the treatment of noise-induced hearing loss was early initiation of dexamethasone therapy. There could be negative effects of HBOT on hearing if it is commenced early after the noise (first 3 h). HBOT treatment, which was started at the 24th hour, was found to be an effective method.

Subcutaneous approximation suture for preventing soft tissue pollybeak deformity.

BACKGROUND: Pollybeak deformity due to abundant fibrosis formation in the supratip region after rhinoplasty is still a common problem. The aim of this study was to investigate the effects of a modified subcutaneous approximation suture on pollybeak deformity of soft tissue origin. METHODS: Three groups, each consisting of eight rabbits, were included in the study. Nasal skin was elevated with an open rhinoplasty approach in all groups. During closure of the skin, to minimize supratip dead space, a horizontal subcutaneous approximation suture was used in group I, external tape fixation was used in group II, and no further action was taken for supratip skin approximation in the control group. Full-thickness supratip skin biopsy specimens reaching down to the underlying cartilage tissue were taken from each subject on the 60th day after the operation. Thicknesses of subcutaneous scar tissues were measured histologically in all groups and compared. RESULTS: The mean thickness of the subcutaneous scar tissues was significantly lower (0.98 ± 0.32 mm) in group I than in group II (1.65 ± 0.61 mm; p = 0.036) and the control group (1.72 ± 0.49 mm; p = 0.019). However, there were no significant differences between group II and the control group in the mean thickness of subcutaneous scar tissues (p = 1.000). CONCLUSION: The findings of this study indicate that the subcutaneous approximation suture is effective for preventing excessive scar tissue formation in the supratip area after rhinoplasty in rabbits. Further clinical studies are needed to determine its efficacy in humans.

Comparison of early postoperative pain among surgical techniques for obstructive sleep apnea.

One of the criticized aspects of surgeries for obstructive sleep apnea (OSA) is postoperative pain. We performed a study to compare the severity of pain occurring after different surgical techniques and to determine analgesic requirements in the first postoperative 24 h. Forty-eight patients with primary snoring or OSA who underwent anterior palatoplasty (AP), lateral pharyngoplasty (LP) or tongue base suspension suture (TBS) were included in this study. A visual analog scale (VAS) was used for measuring pain intensity. Tramadol with patient-controlled analgesia (PCA) device and when necessary rescue pethidine was used for pain relief. VAS pain scores, total PCA-tramadol consumptions and requirement of rescue analgesic in AP, LP and TBS groups were compared. Pain scores in TBS group were higher than AP group in all of the study time points except at 12th hour and LP group until the 10th hour. When compared with AP group, VAS was significantly higher in LP group at the 1st hour. Mean total tramadol consumptions were significantly different between the groups (AP-LP, p = 0.039; AP-TBS, p < 0.001; LP-TBS, p < 0.001). It was highest in the TBS group and lowest in the AP group. In the LP group, three patients (16.7 %) needed rescue analgesia in comparison with 11 (73.3 %) in the TBS group. None of the patients in the AP group needed rescue analgesic. AP is the least painful and TBS is the most painful procedure. PCA-bolus tramadol effectively treats pain caused by AP and LP; however, alleviation of pain caused by TBS usually needs rescue opioid analgesic.

HASTE diffusion-weighted MRI for the reliable detection of cholesteatoma.

PURPOSE: To assess the detection efficiency of Half-Fourier acquisition single-shot turbo spin-echo (HASTE) diffusion-weighted magnetic resonance imaging (MRI) for cholesteatoma. MATERIALS AND METHODS: A total of 21 patients with suspected primary (n=16) or recurrent cholesteatoma (n=5) underwent MRI in a 1.5 Tesla scanner using an adapted protocol for cholesteatoma detection that included a coronal HASTE diffusion-weighted MRI sequence. The cholesteatoma diagnosis was based on evidence of a hyperintense lesion at b-1000 on diffusion-weighted images. The imaging findings were correlated with findings from surgery or clinical evaluations in all patients. RESULTS: HASTE diffusion-weighted MRI successfully detected 11 primary and 5 recurrent lesions out of 17 cholesteatomas (sensitivity, 94.1%). One primary cholesteatoma with a diameter of 4-5 mm was missed. MRI of patients without cholesteatoma were correctly interpreted as negative for cholesteatoma (specificity, 100%). The positive and negative predictive values for the HASTE diffusion-weighted MRI in detecting cholesteatoma were 100% and 80%, respectively. CONCLUSION: HASTE diffusion-weighted MRI offers great promise for cholesteatoma screening. The addition of this sequence to the posterior fossa MRI protocol may preclude unnecessary cholesteatoma surgery.

Unexpected tumor incidence in surgically removed unilateral and bilateral nasal polyps.

OBJECTIVE: The objective of the study was to investigate the postoperative tumor incidence on routine histopathologic examination of surgical specimens in patients who underwent endoscopic sinus surgery with the preoperative diagnosis of unilateral or bilateral nasal polyposis. METHODS: Patients who underwent endoscopic sinus surgery with the preoperative diagnosis of unilateral or bilateral nasal polyposis between 2000 and 2009 were included in the study as the 2 separate groups. In both groups, tumor incidence that had been noticed on routine postoperative histopathologic examination was recorded retrospectively. Patients who had a preoperative diagnosis other than nasal polyposis, determined on biopsy, were excluded. RESULTS: Of 251 patients included, 197 had the preoperative diagnosis of bilateral nasal polyposis, and 54 had unilateral nasal polyposis. No tumor was diagnosed on postoperative histopathologic examinations in patients with preoperative bilateral nasal polyposis. Seven patients (12.96%) with the preoperative diagnosis of unilateral nasal polyposis had tumors on postoperative histopathologic examinations. Two of these 7 patients had malignant tumors that were reported preoperatively by intranasal biopsy as inflammatory polyps. CONCLUSIONS: Diagnosis of a neoplasia is an extremely rare situation, unless there are special findings of tumor in patients with preoperative diagnosis of bilateral nasal polyposis. On the other hand, histopathologic examinations should be carried out in every case operated with preoperative diagnosis of unilateral nasal polyposis, as the tumor incidence is higher.

Relationship between postoperative recurrence rate and eosinophil density of nasal polyps.

OBJECTIVES: Nasal polyps develop as a result of chronic inflammation, mostly accompanied by pronounced eosinophil leukocyte infiltration. In this study we aimed to investigate the relationship between eosinophil density in nasal polyps and the postoperative recurrence rate of this disease. METHODS: Forty-two patients who underwent endoscopic sinus surgery for massive nasal polyposis by one surgeon were included in the study. The eosinophil leukocyte densities in nasal polyps were determined retrospectively on histologic slides by use of computer-assisted image analysis software. The patients were assigned to group 1, in whom nasal polyps contained up to 3 eosinophils per 1,000 microm2, and group 2, in whom nasal polyps contained 4 or more eosinophils per 1,000 microm2. The postoperative recurrence rates of nasal polyps were compared in the two groups. RESULTS: There were 20 patients in group 1 and 22 patients in group 2. Postoperative polyp recurrence was detected in 5 of 20 patients (25.0%) in group 1 and in 18 of 22 patients (81.8%) in group 2 during the 30-month postoperative followup period (p < 0.05). CONCLUSIONS: The eosinophil density of nasal polyps can be used to get an estimate of the postoperative recurrence risk. Eosinophil-rich nasal polyps have a higher postoperative recurrence rate.

Myoepithelioma of the parotid gland in a child: a case report.

Myoepitheliomas of the parotid glands are very rare in the pediatric population. Only a few cases of myoepitheliomas of the salivary glands have been reported in children. They have some similar features with pleomorphic adenoma. However, they may be malignant and infiltrate locally. Hence, histopathologic examination should be considered to differentiate these tumors. The treatment of myoepitheliomas is complete removal of the tumor. We report a child with myoepithelioma of the parotid gland and review the related literature.

Analysis of jugular foramen exposure in the fallopian bridge technique.

OBJECTIVE: To analyze the exposure of the jugular foramen afforded by the fallopian bridge technique. METHOD: The jugular foramen exposure was obtained using the jugular foramen approach combined with the fallopian bridge technique. We applied this technique using 10 temporal bone specimens at a tertiary referral center. The exposure was assessed by means of depth of the dissection field and two separate dissection spaces that were created anteriorly and posteriorly to the facial nerve. Anteroposterior and superoinferior dimensions of the anterior dissection space were 4.4 +/- 1.03 mm and 6.3 +/- 2.49 mm, respectively. The superoinferior and anteroposterior dimensions of the posterior dissection space were 11.7 +/- 2.08 mm and 8.0 +/- 2.95 mm, respectively. The depth of the first dissection field was 8.2 +/- 2.11 mm. After perforating the jugular bulb, the depth of the second dissection field was 16.0 +/- 1.60 mm. RESULTS: The anterior dissection space serves only as an additional visualization space for anatomical orientation to the jugular bulb. Tumor dissection is to be accomplished mainly through the posterior dissection space. CONCLUSION: The fallopian bridge technique should be added to surgical armamentarium for the jugular foramen tumors confined only to the jugular fossa or tumors with middle ear extension.