Clustering upper airway physicals, otitis media with effusion and auditory functions in children.

OBJECTIVE: Adenoid hypertrophy (AH) has been identified as a cause of otitis media with effusion (OME), which is the most common cause of childhood hearing loss. Indeed, there may be other upper airway-related predisposing factors such as, location of the adenoid, accompanying tonsillar hypertrophy (TH) and nasal septal deviation (NSD) for the development of OME. In this study, we aimed to evaluate the associations between the upper airway physicals and OME with auditory functions. METHODS: Eighty-six ears of 43 children, aged 3-11 years were included in this prospective clinical study. Findings of otolaryngologic examinations were noted. Data of pure tone audiometry (PTA), traditional tympanometry (TT) and wideband tympanometry (WBT) parameters were collected. Cluster analysis was performed to the following variables: age, sex; the adenoid choana percentage (ACP), the presences of adenoid around torus tubarius (AATT), TH, NSD and OME; peak pressure (PP) values on TT, resonance frequencies (RF) on WBT, ambient pressure absorbance ratios (APAR) and PTA hearing thresholds. RESULTS: Two groups of ears revealed by clustering; cluster-1 (n = 46) and cluster-2 (n = 40), at the similarity level of 0.662. The presences of AH, AATT, OME and the medians of ACP, PP, RF, WBT APARs at all frequencies except 5656 Hz and 8000 Hz, all PTA thresholds were significantly different between two clusters (p < 0.05). The lower WBT APARs and higher PTA thresholds were associated with higher levels of ACP and higher frequencies of the presence of AATT and OME in cluster-1. CONCLUSION: There are associations between AH, AATT and OME together with decline in hearing and SEA. Whereas, TH and NSD are not related to the formation of clusters and they are insignificant factors.

The influence of age and language on developmental trajectory of theory of mind in children with cochlear implants.

OBJECTIVE: The present study investigates if children with cochlear implants (CI) are associated with delayed development of Theory of Mind (ToM) and the differences in gain of ToM ability with respect to age, language and other aspects of CI. METHODS: One-hundred-eleven children with participation of their hearing parents, aged between 36 months and 132 months, who had congenital profound bilateral deafness and were unilateral CI users; plus 99 healthy children underwent 'Peabody Picture Vocabulary' and 'Sally-Anne' tests. A total of 77 children with CI (mean age: 76.51 months, 31 girls and 46 boys) and 82 healthy children (mean age: 72.41 months, 47 girls and 35 boys) were included in the analyses. Analytic comparisons were created between the controls and children with CI and between subgroups of CI users by univariate and multivariate analysis. The effects of age of hearing aid use, age of CI surgery, duration of CI use, language scores and the presence of risk factors, early rehabilitation with hearing aid and CI on the ToM development were analyzed. RESULTS: The Sally-Anne test success rates of 67.1% were significantly higher in controls than that of children with CI (49.4%) (p < 0.05). The mean age difference of the children, who were successful in Sally-Anne test was 5.33 months in favor of healthy controls. The ToM task success rates were 57.1% (24/42) and 40% (14/35) in children with early CI and late CI respectively. The children, who were good at language, were also better in Sally-Anne tests, but the mean Peabody Picture Vocabulary test scores were indifferent in the same age group with respect to the presence of CI use (p > 0.05). However, multivariate analysis presented the higher language scores as the only significant independent variable that has impact on the success in Sally-Anne test (p < 0.05). CONCLUSION: The results revealed that among all children, who did better in ToM were older in age and better in language skills. Children with CI also performed better in false-belief test depending on their language scores. Early CI surgery, older age, and hence longer CI use can provide a well-developed ToM for children with CI.

Analysis of Otologic Injuries Due to Blast Trauma by Handmade Explosives.

OBJECTIVE: The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations. METHODS: Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified. RESULTS: Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed. CONCLUSION: Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma.

Unilateral Pedunculated Lymphangiectatic Fibrolipomatous Polyp of the Palatine Tonsil: A Rare Case.

Lymphangiomatous polyps are rare benign hamartomatous tumors of the palatine tonsils that can cause significant distress to the patients such as sore throat, foreign body sensation, a lumpy feeling in the throat region, dysphagia, and eventual suffocation. In this paper, the case of a 17-year-old male who came to the outpatient clinic with a complaint of difficulty in swallowing, eventual vomiting, and occasions of hematemesis is presented. On physical examination, the patient had a smooth-surface, polypoid, pedunculated tumoral lesion originating from the middle pole of the left palatine tonsil and protruding into the oropharyngeal isthmus. The patient underwent left tonsillectomy. Histopathological examination of the surgical specimen showed typical features of a lymphangiectatic fibrolipomatous polyp. The case reported herein with the brief literature review points out the clinical and the benign, non-neoplastic characteristics of the lymphangiectatic fibrolipomatous polyp, which can be cured by surgical excision along with tonsillectomy.

Atypical Carcinoid Tumor and Chondroid and Glandular Hamartoma of the Arythenoid Region.

Neuroendocrine tumors of the head and neck are rare. Laryngeal hamartomas are even rarer especially in adult patients. Here in a 69-year-old male patient is presented who had atypical carcinoid tumor and chondroid and glandular hamartoma of the medial mucosa of the left arythenoid. To the best of our knowledge, this is the first case presenting the association of these 2 rare lesions.

Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking.

OBJECTIVE: In this retrospective cohort study, we aimed to determine the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) and to define the possible predictors for PCF formation. METHODS: The medical records of 198 patients with laryngeal squamous cell carcinoma who underwent TL were reviewed. After the exclusion of patients with history of free flap reconstruction, previous laryngeal surgery, and previous radiotherapy (RT) for other primary cancers, the risk factors for PCF were analyzed in 183 patients who were included in the study. RESULTS: The overall incidence of PCF was 20.2%. A history of heavy smoking and previous RT were detected as independent risk factors in both univariate (p=0.004 and p=0.007, respectively) and multivariate (p=0.005) analyses. Preoperative tracheotomy (PT) longer than 14 days was a risk factor for PCF among patients with PT in the univariate analysis (p=0.031). Overall three- and five-year survival rates were statistically indifferent between the PCF and non-PCF groups (p>0.05). However, the overall five-year survival rate was lesser in the persistent PCF group (47%) than in the non-persistent PCF group (83%) (p=0.038). CONCLUSION: Heavy smoking and previous RT are independent risk factors for PCF, and the persistence of PCF decreases survival rates. Preventable measures should be taken to decrease the incidence and persistence of this complication of TL in the management of patients with possible risk factors.