Magnetic Resonance Imaging of the Eustachian Tube and the Paratubal Structures in Patients with Unilateral Acquired Cholesteatoma.

OBJECTIVES: This study aimed to compare the Eustachian tube (ET) and the paratubal structures between the two sides in subjects with unilateral acquired cholesteatoma and a healthy contralateral ear to determine if there are anatomical differences. MATERIALS AND METHODS: Of the 217 patients with cholesteatoma evaluated, 36 patients with unilateral cholesteatoma were included in the study. All of the patients had a healthy contralateral ear with no history of surgery. Nine different paratubal parameters were measured through contrast-enhanced magnetic resonance imaging (MRI). The measurements of the ear with cholesteatoma were compared with those of the healthy ear. RESULTS: The bimucosal thickness of the ET lumen, the mucosal thickness of the pharyngeal orifice, the lengths and diameters of the tensor veli palatini muscle and the levator veli palatini muscle, the diameter of the pharyngeal orifice of the ET, the diameter of the lateral pharyngeal recess mucosal thickness, and the diameter between the posterior border of the inferior nasal concha and the pharyngeal orifice of the ET were measured in MRI scans. No statistically significant difference was observed between the healthy ear and the ear with cholesteatoma for any of the parameters measured (p>0.05). CONCLUSION: We did not observe any anatomical differences in the measurements of the ET and the paratubal structures on MRI scans. Although ET dysfunction is considered to be the leading etiologic factor in acquired cholesteatoma, the ET and the paratubal structures may not exhibit an anatomic difference between the ear with cholesteatoma and the healthy contralateral ear.

The Relationship Between Nasal Septal Deviation and Paranasal Pneumatization.

OBJECTIVE: To investigate the impact of the presence and the severity of the nasal septal deviation (NSD) on the paranasal pneumatization. METHODS: Initially, the deviated and contralateral sides was compared to evaluate the impact of the presence of NSD on pneumatization. Then, NSD classification groups were categorized according to the severity of deviation degree; 1: mild (<9°), 2: moderate (9°-15°), and 3: severe (>15°). Pneumatization of all paranasal sinuses, osteomeatal complex (OMC), frontoethmoid recess (FER) and variant structures were compared according to the NSD classification groups separately both for the deviated and the contralateral sides. RESULTS: Although there was no statistically significant difference in pneumatization of the paranasal sinuses between the deviated and contralateral sides, a significant difference was observed in OMC and FER diameters. In the deviated side, there was statistically significant difference in ethmoid sinus volume, in FER and OMC diameters between NSD classification groups. In the contralateral side, FER and OMC diameters were found to be significantly different between group 1 and group 2 and between group 1 and group 3, respectively (P = 0.04 and 0.06, respectively). Both the presence and severity of the NSD did not statistically significant influence the pneumatization of variant structures, air cells and vital structures. CONCLUSION: The severity of NSD effects the ethmoid sinus volume. The relationship of FER and OMC with NSD is evident, however this may not always be in a proportional pattern. The paranasal pneumatization did not affect Keros type, bone integrity of carotid canal and optic canal.

Is Salvage Hyperbaric Oxygen Therapy Effective for Sudden Sensorineural Hearing Loss in Patients with Non-response to Corticostreoid Treatment?

PURPOSE: The aim of this study was to evaluate the efficacy of salvage hyperbaric oxygen therapy (HBOT) for sudden sensorineural hearing loss (SSNHL); HBOT is performed after three weeks of the onset of the disease. METHODS: This retrospective clinical study included patients with unilateral idiopathic SSNHL. All patients admitted to the hospital with the diagnosis of SSNHL were given standard steroid treatment within the 14 days of the onset of the SSNHL. We compared the two study groups - Group A: patients receiving steroid treatment within the first 14 days; Group B: patients receiving corticosteroid treatment within the first 14 days, but unresponsive to this treatment, and began to receive HBOT after three weeks of the onset of SSNHL for the purpose of salvage therapy. RESULTS: A total of 50 patients were included in the study. The mean age of the patients was 50.6 ± 14.1 years. There was not a significant difference in the degree of hearing loss between the groups based on the findings from audiometric examinations performed at the time of diagnosis. It was observed that salvage HBOT was not effective when the initial and post-treatment audiometric tests were compared. CONCLUSION: According to our results, salvage HBOT was not efficient when performed three weeks after the onset of the SSNHL for patients who did not respond to corticosteroid treatment.

Graft Success and Hearing Results between Cartilage Island Graft and Temporal Muscle Fascia Graft Myringoplasty.

OBJECTIVE: To compare the graft success and hearing results in patients who underwent cartilage island graft (CIG) myringoplasty and temporal muscle fascia graft (TFG) myringoplasty. STUDY DESIGN: Retrospective clinical study. PLACE AND DURATION OF STUDY: Ankara Numune Training and Research Hospital, Otolaryngology Clinic, Ankara, from January 2013 to January 2018. METHODOLOGY: Patients who underwent cartilage island graft myringoplasty and temporal muscle graft myringoplasty for chronic non-suppurative otitis media were inducted. Age, gender, preoperative audiologic examination results, postoperative audiologic examination, perforation site, graft material, preoperative microscopic examination and graft success were documented. RESULTS: A total of 116 patients were included in the study. The mean age of the patients was 35 ±15.3 years. Fifty-four patients were females and 62 were males. Temporal muscle fascia graft was applied to 68 (58.6%) patients, while cartilage graft was applied to 48 (41.4%) patients. The success rate of graft was found to be 80.2% (55 cases with graft success) in TFG; whereas, this rate was found to be 93.8% (45 cases with graft success) in CIG group. Cartilage island graft material had a better graft success in terms of graft endurance (p = 0.048). There was no statistically significant difference between the two graft materials in terms of postoperative hearing success (p = 0.29). CONCLUSION: Cartilage island grafts can be preferable for myringoplasty operations.

Cautionary Findings for the Presence of Facial Canal Dehiscence During Cholesteatoma Surgery.

Our aim was to investigate the relationship between facial canal dehiscence (FCD) and surgical findings and procedures in patients with cholesteatoma. A total of 186 patients (118 males, 39.2 ± 15 years) who underwent surgery for advanced cholesteatoma between 2013 and 2018 were included in the study. The relationship between FCD and surgical findings was investigated via the surgical registries. The prevalence of FCD was 36.6% (68/186). The prevalence of FCD was 44%, and 13.2% for the patients who underwent canal wall down mastoidectomy (62/141) and canal wall up mastoidectomy (6/45), respectively (P < .001). Facial canal dehiscence was detected in 73.9% of the 23 patients who had a lateral semicircular canal (LSCC) defect (P < .001), in 61.9% of 21 patients who had a tegmen tympani defect, and in 58.1% of the 31 patients who had erosion on the posterior wall of the external auditory canal (EAC; P < .05). The prevalence of FCD was 3.1% in patients with isolated incus erosion, 59.1% in patients with erosion of malleus and incus, 60.7% in patients with erosion of stapes suprastructure and incus, and 43.2% in patients with whole ossicular chain deformation (P < .001). The defects on LSCC, EAC, tegmen tympani, and malleus and incus might be cautionary findings for the presence of FCD during cholesteatoma surgery.

The effect of surgical margin positivity on survival in laryngeal cancer surgery.

AIM: The aim of this retrospective study was to investigate possible factors affecting the survival in patients who were operated due to laryngeal squamous cell carcinoma (SCC) MATERIAL AND METHOD: The study included patients who underwent surgery in our clinic due to laryngeal SCC between May 2010 and June 2018. It was learned whether the patients were alive or not by hospital records, death notification system records and patient / family interviews. Surgical reports, pathology reports, tumor clinical council notes and preoperative hematological examinations were retrospectively evaluated and recorded from the hospital registry system. RESULTS: The mean age of the 63 patients included in the study was 59.3 (age range; 38 to 83 years). The mean postoperative follow-up period was 56.8 months (minimum 6 months to maximum 102 months). We found that surgical margin positivity had a statistically significant negative negative effect on survival (p = 0.049, r = -0.26). Perineural invasion, perivascular invasion, the presence of neck metastasis and the effect of tumor differentiation on survival were not found to be statistically significant (p values; 0.9, 0.1, 0.9 and 0.4, respectively). CONCLUSION: The absence of a tumor at the surgical margin is one of the most basic rules in oncologic surgery. KEY WORDS: Laryngeal carcinoma, Oncologic surgery, Survival, Surgical Margin.

Lymph node yield and lymph node density for elective level II-IV neck dissections in laryngeal squamous cell carcinoma patients.

PURPOSE: To determine the minimum lymph node yield (LNY) in patients with laryngeal squamous cell carcinoma (LSCCs). METHODS: This retrospective study was performed in a tertiary care hospital setting and included 42 LSCC patients aged 39-81 years (females, n = 2; males, n = 40) who underwent a total or partial laryngectomy and elective bilateral level II-IV neck dissections (unilateral neck dissections: n = 84). RESULTS: The average LNY in the unilateral level II-IV lymph node dissections was 25.9 ± 10, and the average metastatic LNY was 0.9 ± 1.9. The unilateral neck dissections were grouped according to the number of lymph nodes. There was no significant difference between the groups in terms of the metastatic LNY (p = 0.5). The metastatic lymph node density (LND) (metastatic lymph node yield/LNY) was 0.043 for unilateral neck level II-IV neck dissections. A Cox regression analysis revealed no significant relationship between survival and the LNY and LND in bilateral neck dissections (p = 0.4 and p = 0.8, respectively). CONCLUSIONS: The results revealed no minimum number of lymph nodes that could reliably detect metastatic lymph nodes in LSCC patients.

Hearing outcomes after suppurative chronic otitis media surgery.

OBJECTIVES: This study aims to compare the hearing outcomes after canal wall up mastoidectomy (CWUM) and canal wall down mastoidectomy (CWDM). PATIENTS AND METHODS: Ninety-two patients (74 males, 18 females; mean age 30.1 years; range 9 to 67 years) who were diagnosed with chronic suppurative otitis media (CSOM) between January 2009 and May 2011 were enrolled in this retrospective study. Based on hospital data, patients were separated into two groups as having mucosal or squamous disease. Patients were also categorized into two groups based on the type of mastoidectomy: CWUM (n=51) and CWDM (n=41). Hearing results between the groups were evaluated using the air-bone gap (ABG) recorded by audiogram before surgery and at three months after ossiculoplasty. Relationship between obtained hearing results and performed ossiculoplasty techniques were also discussed. RESULTS: We were able to perform ossiculoplasty in 42.3% (n=39) of patients diagnosed with CSOM. Presurgical ABG in CWUM and CWDM groups were 35.38±10.82 dB and 37.92±5.80 dB, respectively. Postsurgical ABG value was ≤20 dB in 27% of CWUM patients and 7.7% of CWDM patients. Mean hearing gain of patients with active squamous disease was 3.8 dB in CWUM group and 11.9 dB in CWDM group (p<0.5). CONCLUSION: The pathology affecting the middle ear had influence on the hearing results of the two groups. Canal wall down mastoidectomy may be a beneficial procedure to improve hearing in patients with CSOM.

Increased carotid artery intima-media thickness in patients with tympanosclerosis: Common risk factors with atherosclerosis?

We investigated the relationship between tympanosclerosis, known atherosclerotic risk factors, and the intima-media thickness of bilateral carotid arteries using ultrasonography. A total of 122 patients admitted to our clinic with chronic otitis media between 2005 and 2010 were included in the study. The study group consisted of 61 patients with tympanosclerosis; the control group comprised 61 patients without tympanosclerosis. Internal carotid artery intima-media thickness (CAIMT), total cholesterol, triglyceride, low- and high-density lipoprotein cholesterol, C-reactive protein, and homocysteine levels were measured in all patients. Homocysteine, low-density lipoprotein, total cholesterol, and triglyceride levels in the study group were higher compared with those of the control group (p < 0.05). Right and left CAIMT was greater in the study group versus the control group (p ≤ 0.001). In conclusion, atherosclerosis and tympanosclerosis were associated with identical risk factors; in the tympanosclerosis group, CAIMT was increased significantly.

Vestibular functions were found to be impaired in patients with moderate-to-severe obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: Obstructive sleep apnea (OSA) and balance disorders are common chronic diseases seen in the general population. The aim of this study was to evaluate vestibular functions in individuals with OSA. STUDY DESIGN: Cross-sectional clinical study. METHODS: Patients who were referred to the sleep clinic in our hospital were classified into two groups according to a polysomnographic test: a moderate-to-severe OSA group and a mild OSA group. A vestibular system assessment of all patients was performed subjectively with the Dizziness Handicap Inventory (DHI) survey and objectively with videonystagmography. RESULTS: The current investigation produced four major findings: 1) Apnea-hypopnea index was significantly correlated with age and body mass index, whereas it was not correlated with Epworth Sleepiness Scale scores. 2) There was a significant difference in study groups in terms DHI scores, particularly in the physical subgroup. Moderate-to-severe OSA patients had higher scores in the physical subgroup of DHI. 3) Nystagmus and canal paresis rates were significantly higher in the moderate-to-severe OSA group when compared to the mild OSA group. 4) Results of the Romberg test, tandem Romberg test, cerebellar examinations, and positional tests were normal in both. CONCLUSIONS: Abnormal vestibular responses are common in individuals suffering from severe OSA, and dizziness has negative effects on the quality of life in these individuals. LEVEL OF EVIDENCE: 4

Surgical approach and outcomes for revision surgery of the central neck compartment.

Revision surgery of the central neck compartment is still a controversial subject, and data are scarce in the literature regarding surgical approaches and outcomes. This might be a result of the small number of patients in need of revision of the central neck compartment. Therefore, the purpose of this study was to document the approach and outcomes for revision surgery of the central neck compartment performed in our clinic. The files of patients who had undergone revision surgery of the central neck compartment in the Clinic of Otorhinolaryngology, Ankara Numune Training and Research Hospital, between 2007 and 2013, were evaluated. The subjects included 61 patients who had previously undergone surgical intervention in the central neck compartment and had then undergone bilateral lymph node dissection covering at least levels 6 and 7 in our clinic. Patient ages ranged between 36 and 63 years (mean, 47.2 y; SD = 8.3 y). The complications seen after revision surgery were temporary recurrent laryngeal nerve palsy in 4 patients (6.6%), temporary hypocalcemia in 8 patients (13.1%), and permanent hypocalcemia in 3 patients (4.9%). No permanent recurrent laryngeal nerve damage, wound infection, or hematoma was encountered. Meticulous surgical dissection with identification of the recurrent laryngeal nerve and the implantation site of the parathyroid glands may safeguard against complications. Reoperative surgery in the central compartment of the neck allows the removal of recurrent/persistent disease and has acceptable morbidity.

Changes in Acoustic Parameters of Voice After Endoscopic Sinus Surgery in Patients with Nasal Polyposis.

Our aim was to evaluate acoustic voice analysis of patients diagnosed with nasal polyps before and after endoscopic sinus surgery. Forty-three patients diagnosed with nasal polyposis who had undergone endoscopic sinus surgery were included in this prospective study. Patients were divided into three groups according to the stage of nasal obstruction before the surgery. Acoustic voice analyses were performed on each patient before the endoscopic sinus surgery and six weeks following the surgery with the multi-dimensional voice program. Jitter, shimmer, F0 frequency, and noise to harmonic ratio (NHR) parameters were obtained for acoustic analysis. Our investigation showed that Jitter, shimmer and NHR values decreased, and F0 value increased in the postoperative period in patients that had a partial nasal obstruction before the surgery. Non-significant increases were also observed in these four parameters after the surgery in cases with total or near-total nasal obstruction. We also found that the postoperative changes in shimmer values between the Stage III patients and the patients in other stages were statistically significant (P = 0.027). Voice changes that became more marked with increasing stages of the nasal polyposis. According to our results, patients should be informed of the possible alterations in speech following major surgical interventions on the paranasal sinuses.

Sinonasal tract malignancies: prognostic factors and surgery outcomes.

BACKGROUND: Cancers of the sinonasal region are rare and its survival rate remains poor because most of the patients are asymptomatic and diagnosed in advanced stages with surrounding important structures. OBJECTIVES: This study attempted to analyze the clinical and histological features in addition to survival and prognostic factors of surgical treatment of sinonasal cancers. PATIENTS AND METHODS: A retrospective cohort study, involving 36 patients with sinonasal cancer who were treated with surgery in our hospital between 2000 and 2010, was performed. Patients were selected based on the convenience sampling. Patients treated with radiotherapy and/or chemotherapy were excluded from the analysis. Clinical symptoms and histologic findings of patients as well as malignant tumor staging and its prognosis were collected from archives. RESULTS: We found that overall 3 and 5-year survival rates of subjects were 52.8%, and 41.6%, respectively. There was a negative correlation between the clinical stage and survival. There was a significant difference between infrastructural and suprastructural localization in 5-year survival rate (P = 0.018). In the present study, there was a strong relationship between the local control and overall survival (P < 0.01). Overall 5-year survival rate was similar in patients both in the exenterated orbit and preserved orbit (P > 0.05). CONCLUSIONS: The present study has demonstrated that clinical stage, suprastructural tumor, and the presence of tumor- positive resection margins are the most significant prognostic factors affecting local tumor control and survival. As a result of this study, these tumors should be treated in early stages by surgical margin of resection followed by adjuvant radiotherapy.

[Evaluation of the oropharyngeal tularemia cases admitted to our hospital from the provinces of Central Anatolia]. / Orta Anadolu Bölgesi Illerinden Hastanemize Basvuran Orofaringeal Tularemi Olgularinin Degerlendirilmesi.

Tularemia caused by the bacterium Francisella tularensis is a zoonotic infection which has re-emerged in Turkey in recent years as water-borne endemics. Oropharyngeal form is the most frequently reported form of the disease from Turkey. The aim of this study was to evaluate the clinical and laboratory findings of oropharyngeal tularemia patients admitted to ear, nose & throat outpatient clinic between January-March 2010. A total of 10 patients (age range: 16-80 years, mean age: 43.9 years; nine were male) inhabiting in the provinces in Central Anatolia, Turkey, were admitted to our hospital with the complaints of fever, sore throat and painful cervical lump. They have been previously diagnosed as tonsillo-pharyngitis at different medical centers and empirical antibiotic therapy has initiated, however, their complaints have not recovered. Endoscopic laryngoscopic examination revealed that oropharynx, larynx and hypopharynx were normal. Physical examination of the neck yielded localized fixed masses with diameters between 2-7 cm. The lesions were localized at right submandibular (n= 4), upper jugular (n=3) and one of each at left posterior cervical, left submandibular and left jugulodigastric regions. The patients were hospitalized with the pre-diagnosis of "neck mass with unknown origin" for further investigation and treatment. The mean white blood cell count of the cases was 9730 (7500-15.100) cells/µl; the mean erythrocyte sedimantation rate was 68.7 (46-85) mm3/hours and the mean C-reactive protein level was 4.3 (1.5-7.4) µg/dl. Salmonella, Brucella, Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex virus, Epstein-Barr virus and viral hepatitis serology did not indicate acute infections. Serum and tissue samples were sent to Refik Saydam National Public Health Agency in order to test for tularemia, namely culture, microagglutination test (MAT), direct fluorescence antibody (DFA) test and in-house polymerase chain reaction (PCR). All of the patients (10/10) were found positive for tularemia by F.tularensis MAT yielding antibody titers of ≥ 1:640. Lymph aspirate samples could be collected from seven cases and of them 5 (71.4%) were found positive by PCR, while 3 (42.9%) were positive by DFA test. PCR which was performed with the use of RD1 primers yielded F.tularensis subsp. Holarctica. The cultures of blood, urine, lymph aspirates and throat swabs were negative for F.tularensis growth. Of 10 patients two had the history of animal contact and four had consumed fountain water. Nine of the cases were treated with 10 days streptomycin and one with doxycycline, and all were discharged with complete cure. In conclusion, tularemia should be considered in the differential diagnosis of patients with painful lumps in the neck and didn't recover with empirical antibiotic therapy directed against tonsillopharyngitis, particularly in endemic areas.

Changes in the ocular and nasal cultures in patients who had undergone septoplasty.

OBJECTIVE: The aim of the study was to evaluate the microbiologic changes that occurred in the nasal and ocular mucosa before and after surgery in patients who had undergone septoplasty. DESIGN SETTING: Fifty-five patients who applied to our clinic with septal deviation were included in the study. METHODS: Before and after the operation, samples were taken from the ocular and inner nasal mucosa for cultures and direct microscopic evaluation and the microbiologic changes were compared. MAIN OUTCOME MEASURES: The results of ocular preoperative cultures were different from the results of postoperative cultures. RESULTS: The most frequent microorganisms in all pre- and postoperative ocular and nasal cultures were similar; coagulase-negative Staphylococcus, Staphylococcus aureus, and Diphtheroid spp were dominant. Following septoplasty, the rate of determining microorganisms in the eye in both microscopic evaluation and cultures had increased. In the postoperative period, the rate of growing S. aureus increased in ocular cultures (p < .01) while remaining the same in nasal cultures. CONCLUSIONS: These results suggest that ocular flora can indeed change following septoplasty; however, the risk of ocular infection is not increased. This is the first study to investigate the risk of ocular infection in addition to local nasal infection after septoplasty.

Do single-photon emission computerized tomography findings predict severity of chronic rhinosinusitis: a pilot study.

BACKGROUND: Chronic rhinosinusitis (CRS) is basically an inflammatory disease of the mucosa and periosteum of the sinuses. The possibility of local osteitis can cause persistent mucosal inflammation and lead to failure of treatment. Bone scintigraphy is the gold standard procedure for detecting the bone involvement. This study was designed to evaluate whether single-photon emission computerized tomography (SPECT) findings predict severity of chronic sinusitis and subjective response to medical treatment. A prospective case control study was done. METHODS: Twenty-four patients with CRS were involved. SPECT findings for bone involvement and computed tomography-based staging (limited disease, stage 1; extensive disease, stages 2 and 3) were compared. These data were also analyzed in terms of subjective response to medical treatment and prognosis. RESULTS: SPECT uptakes were positive in 79.2% (19/24) and negative in 20.8% (5/24) of the patients. SPECT was positive in 4/8 of the patients with limited disease and 15/16 of the patients with extensive disease. In subjective assessment of medical treatment 5/8 of the limited disease versus 1/16 the extensive disease patients had good response; whereas 5/5 of SPECT(-) patients versus 1/19 of SPECT(+) patients had good response. CONCLUSION: Bone SPECT results were found to be correlated with the stage of CRS. Poorer subjective response was observed in patients with positive SPECT.

Expression of histamine receptors (H(1), H(2), and H(3)) in the rabbit endolymphatic sac: an immunohistochemical study.

OBJECTIVE: The endolymphatic sac (ES) is part of the membranous labyrinth of the inner ear. Its central role in immunologic activity within the inner ear has been confirmed by numerous studies. The aim of this study was to investigate the expression of histamine receptors (H(1), H(2), H(3)) in the rabbit ES. METHODS: A total of 10 healthy male New Zealand white rabbits weighing 2 to 3 kg were used in the experiments. For immunohistochemical studies, immunostaining was performed according to the avidin-biotin-peroxidase complex technique. RESULTS: Serial sections of the ES of rabbits revealed the presence of H(1), H(2), and H(3) receptor immunoreactivity. Immunoreactive cells for all H(1), H(2), and H(3) were found in the epithelial and subepithelial layers of the duct and the proximal ES. In conclusion, this study showed the immunohistochemical localization of H(1), H(2), and H(3) receptors in the ES of rabbits. These receptors may be important in the homeostasis of the inner ear. In addition, they may be target receptors in the medical treatment of inner ear disorders such as endolymphatic hydrops.

Evaluation of cochlear involvement by distortion product otoacoustic emission in Behçet's disease.

OBJECTIVE: The aim of this study was to investigate cochlear involvement in patients with Behçet's disease. MATERIALS AND METHODS: Twenty-six Behçet's disease patients (52 ears) and 24 sex and age-matched healthy control subjects (48 ears) were included in the study. Pure-tone audiometry at frequencies 250, 500, 1000, 2000, 4000, 6000 Hz, immittance measures including tympanometry and acoustic reflex testing and DPOAE (distortion product otoacoustic emission) testing were performed in the patients and controls. RESULTS: A sensorineural hearing loss was found in eight patients (30.7%) as it was bilateral in five and unilateral in three patients. Although no typical audiometric configuration was found, one patient had a flat type audiogram, and the others had a high frequency hearing loss. The DPOAE responses of the patients and controls were significantly different in all frequencies (p<0.05). CONCLUSION: These results indicate that cochlea is affected by damage of outer hair cells in Behçet's disease.

An alternative model for stapedectomy training in residency program: sheep cadaver ear.

To determine the usefulness of sheep cadaver ear as a complementary model for training of stapedectomy at residency programs, 2 of our 4 year residents were included in the study and each operated 20 sheep ears. All routine steps of stapedectomy operation were performed, and their success and complication scores were recorded. Performance of residents for stapedectomy and teflon piston placement in sheep ears were evaluated by the authors. Success of both residents improved progressively. Success and complications were impressively better in the second 10 ears than the initial 10 for each resident. Both residents had better outcomes in last 10 ears. Sheep cadaver ear is an excellent model for stapedectomy training in residency and helps to improve surgical skills. We offer sheep cadaver ear training model especially in the countries where obtaining human cadaver temporal bone is difficult.

[Unusual distant metastasis of larynx carcinoma: a case report]. / Larenks kanserinde sik görülmeyen uzak metastaz: Olgu sunumu.

Although distant metastasis from larynx carcinoma is more common in the late stages, it may sometimes occur in the initial period of the disease. The tumor spread may be by a lymphatic or nonlymphatic route. A 40-year-old male patient presented with complaints of hoarseness and shortness of breath. Indirect laryngoscopic examination showed a vegetable mass extending from the left laryngeal side of the epiglottis to the left vocal cord. Level 3 lymphadenopathies were noted in the jugular region. Biopsy result revealed epidermoid carcinoma. Magnetic resonance imaging performed due to complaints of back pain and foot numbness demonstrated aggressive spinal cord metastases. The patient died on the tenth day of hospitalization.