Epithelioid Hemangioendothelioma of the Mastoid Bone with Extension of Middle Cranial Fossa: A Case Report.

Epithelioid hemangioendothelioma (EHE) is a rare sarcoma of vascular origin. It is frequently seen in the liver, lungs and bones. Cases with mastoid bone and intracranial extension are rarer. A 40 year old male, presented with a history of progressive headaches and a mass in the postauricular region for a duration of three months. Computer tomography of the temporal bone showed an approximately 40 × 30 mm soft tissue with osteolytic bony changes located in the mastoid bone. Epithelioid hemangioendothelioma is a rare sarcoma of vascular origin. Surgery is the first line of therapy. Prognosis is generally good, and may be better for primary intracranial disease than that for EHE originating elsewhere.

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus.

OBJECTIVES: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus. METHODS: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. RESULTS: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1-5). CONCLUSION: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.

Comparison of fiber delivered CO2 laser and electrocautery in transoral robot assisted tongue base surgery.

To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.

A Comparison of Cartilage Palisades and Temporal Fascia in Type 1 Tympanoplasty for Bilateral Tympanic Membrane Perforations in Children.

OBJECTIVE: To compare the graft success rates and audiological outcomes of bilaterally performed type 1 tympanoplasty using cartilage palisades or temporal fascia in children. MATERIALS AND METHODS: We retrospectively analyzed the medical records of patients who underwent type 1 tympanoplasty at Medical Park Hospital between May 2007 and February 2013. 27 patients (54 ears) were enrolled in the study: 15 (30 ears) in the palisade cartilage group and 12 (24 ears) in the fascia group. RESULTS: The graft success rate for the fascia group was 79.2%, and that for the cartilage group was 96.7%. The difference was statistically insignificant (p=0.078). Audiological improvements were seen in both groups, and the difference was statistically insignificant. CONCLUSION: The use of temporalis fascia grafting has similar outcomes to palisade cartilage tympanoplasty for both success rate and audiological values in children who have bilateral disease.

Comparison of Hyaluronic Acid Fat Graft Myringoplasty, Fat Graft Myringoplasty and Temporal Fascia Techniques for the Closure of Different Sizes and Sites of Tympanic Membrane Perforations.

OBJECTIVE: To compare the efficacy of three different myringoplasty techniques, namely hyaluronic acid fat graft myringoplasty (HAFGM), fat graft myringoplasty (FGM), and temporal fascia for the closure of different sizes and sites of tympanic membrane perforations. MATERIALS AND METHODS: We retrospectively analyzed the medical records of patients who had undergone a type 1 tympanoplasty operation at our clinic between May 2007 and February 2013. The patients were divided into three groups depending on the patient's choice of technique as follows: Fat Graft Myringoplasty (FGM) (Group I), Hyaluronic Acid Fat Graft Myringoplasty (HAFGM) (Group II), and Temporalis Fascia (TF) (Group III). A total of 136 patients were included in the study, split in to the FGM (57 patients; 56.1% female; median age: 30 years), HAFGM (31 patients; 54.8 female; median age: 25 years), and TF (48 patients; 58.3% females; median age: 33 years) surgery technique groups. RESULTS: The patients were further divided into two groups, depending on the size of the perforation (small and large), and into three groups, depending on its location (anterior, inferior, and central). None of techniques provided a significantly better success rate in terms of perforation location (p>0.05). Also, none of the techniques provided a significantly better success rate in terms of perforation size (p>0.05). CONCLUSION: We propose using HAFGM for large perforations and FGM alone for small perforations. The TF technique is a successful and well-defined technique for tympanic membrane perforations; however, in our opinion, its technical difficulties make it a secondary choice, particularly for small-sized perforations.

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study.

OBJECTIVES: (1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air-bone gap. METHODS: A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups. RESULTS: Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p > 0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p < 0.05). The improvement in the mean air-bone gap was 14.1 dB in Group 1 and 12.4 dB in Group 2 on post-operative day 45 (p < 0.05). CONCLUSIONS: In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.

A novel predictive marker for the recurrence of nasal polyposis following endoscopic sinus surgery.

We aimed to determine the value of neutrophil-to-lymphocyte (NLR) ratio for prediction of recurrence in patients subjected to endoscopic sinus surgery. Higher neutrophil counts mean more chronic inflammation so the NLR value could show the inflammatory level resulting with higher incidence of recurrence. From January 2011 to March 2013, we performed a retrospective review of the complete blood count samples from 192 patients with chronic sinusitis who underwent endoscopic sinus surgery. The patients were divided into two groups based on the presence of nasal polyps. NLR and platelet-to-lymphocyte (PLR) ratios were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value for significant differences in variables between the recurrence and non-recurrence groups. The ROC analysis results revealed an NLR cut-off of 3.13 and a PLR cut-off of 208.75. Our analysis revealed that NLR is an independent risk factor for recurrence of chronic sinusitis in patients subjected to endoscopic sinus surgery (p = 0.006), whereas the PLR was not a predictive factor for recurrence (p = 0.167). Our study revealed that the NLR could be used to predict disease recurrence before endoscopic sinus surgery. However, additional studies are needed to confirm these results.

A novel predictive marker for the viscosity of otitis media with effusion.

OBJECTIVES: To evaluate the significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the prediction of the viscosity of otitis media with effusion. METHODS: This retrospective study was performed on 81 patients who were admitted to the otolaryngology clinic.The patients were divided into two groups according to their effusion type, as serous or mucoid, which was defined intraoperatively after myringotomy. The NLR and PLR were calculated as a simple ratio between the absolute neutrophil/platelet and absolute lymphocyte counts.Tympanostomy tube insertion was performed for all cases.Under direct visualization, the effusion was aspirated and classified as serous or mucous. RESULTS: We postulated that an NLR value of less than 1.38 may show mucoid effusion and if the PLR value is less than 97.96, the effusion is mucoid. CONCLUSIONS: We speculate that a useful predictor of viscosity for a middle ear effusion could prevent unnecessary surgeries and additional costs in the treatment of EMO. Additional studies are needed to confirm our results.

Influence of size and site of perforation on fat graft myringoplasty.

OBJECTIVES: In this retrospective study, we investigated the outcomes of fat graft myringoplasty (FGM) in different perforation sizes and locations. The outcomes were evaluated in terms of closure rates and audiological test results. METHODS: The study population included 172 patients who were operated between 2007 and 2012. 161 had unilateral and 11 had bilateral chronic otitis media; and 183 ears were operated by FGM. The patients were divided into two groups based on size as small and larger (size of ≤30 of TM was defined as small perforations, and size of >30% TM was defined as a medium-large perforations); and two groups based on location of perforation [anterior and other (non-anteriorly located)]. Patients' follow-ups were performed between 1 and 5 years; and follow-up examinations were performed with otoendoscopy. Air conduction (AC) thresholds and air-bone gap (ABG) were evaluated both preoperative year and postoperative 1st year. RESULTS: The total perforation closure rate was 84.7%. In this study, we found out that FGM is effective closing medium-large perforations just as small perforations with the success rate of 79.1% and 86.4% respectively (p>0.05). When audiological outcomes were evaluated in both groups, AC values got lower and ABG values improved postoperatively, whereas regarding AC thresholds and ABG improvement among the size groups, patients with small perforations had significantly better postoperative results (p<0.05). In terms of perforation location, closure rates were 85.2% in anteriorly perforations and 84.5% in the other located perforations. Audiological outcomes demonstrated that in both groups, AC values got lower and ABG values improved postoperatively; and hearing results were not different in anteriorly located perforations and other locations. CONCLUSION: Fat graft myringoplasty (FGM) may be used in all small and medium-large, and anteriorly and other located perforations. Although hearing improvement was detected in each of the small; and medium-large perforations; patients with small perforations had more satisfied audiological outcome than medium-large perforations.

Venous outflow of the brain after bilateral complete jugular ligation.

A case of a patient with bilateral internal, external, posterior external and anterior jugular vein ligations and excisions performed in the neck due to a larynx tumor is presented. Radical neck dissection is a standard otorhinolaryngological procedure in the management of head and neck cancer patients with bilateral lymph node metastasis to the neck. Sacrifice of both internal and external jugular veins bilaterally has been recognized as a dangerous approach leading to intracranial hypertension with subsequent neurological sequela and death. In this report, we aimed to demonstrate how venous outflow from the brain diverts after jugular venous system obliteration. After bilateral jugular vein ligations, digital subtraction angiography (DSA) showed that the venous drainage route of the brain had been diverted from the jugular veins to the vertebral venous plexus.

Giant cell reparative granuloma originating from the ethmoid sinus.

Giant cell granuloma is a reactive osseous proliferation and is histologically benign despite its aggressive clinical course. It usually involves the maxilla and the mandible in the region of the head and neck. It is rare in the ethmoid region. In this paper, an aggressive and recurrent giant cell reparative granuloma, which is recurred in a very short time period, originating from the ethmoid sinus is presented and the criteria for the differential diagnosis are noted in the light of the histological, clinical and biochemical parameters and the literature is reviewed.