Single Sequence Magnetic Resonance Imaging in Serous Otitis Media.

INTRODUCTION: We evaluated the usability of short-term (approximately 3 minutes) T2 sequence temporal bone magnetic resonance imaging (MRI) in the diagnosis of serous otitis media (SOM) in our study. METHODS: A prospective study. Otoscopic examination and audiometry-tympanometry were performed on all 73 patients included in the study. All patients underwent short-term T2 sequence temporal bone MRI before the paracentesis procedure. RESULTS: The mean age of 73 patients (30 female and 43 male) was 7.78 ± 3.01 (3 to 17 years). A total of 134 ear paracentesis operations were performed. As a result of the intraoperative paracentesis procedure, 107 Type B tympanogram and 13 Type C tympanogram were found out of 120 ears that had fluid in the middle ear. Out of 14 ears without fluid flow in the middle ear, five were found to be Type B tympanogram and nine to be Type C tympanogram. The sensitivity of the type B tympanogram in the diagnosis of SOM was 89.1%, the specificity was 64.2%, the positive predictive value was 95.5%, and the negative predictive value was 40.9%. The sensitivity and specificity of short-term T2 sequence MRI in diagnosing SOM were found to be 100% and 100%. CONCLUSION:  Among the available methods, the short-term T2 sequence temporal MRI is the most effective method for evaluating fluid in mastoid cells.

The evaluation of tinnitus and auditory brainstem response in benign paroxysmal positional vertigo accompanied by tinnitus.

PURPOSE: The aim of this study is to investigate auditory brainstem response (ABR) in patients with benign paroxysmal positional vertigo (BPPV) accompanied by tinnitus and to suggest possible interpretative hypotheses. METHODS: Ninety individuals were included in the study. Individuals were separated into three groups: patients reporting tinnitus with BPPV (Group I), patients with BPPV (Group II), and a control group. The ABR test was applied at a low and at a high rate. RESULTS: For patients reporting tinnitus with BPPV, tinnitus was found to be localized in the ear affected by BPPV. Tinnitus disappeared after therapeutic interventions in 23 individuals with tinnitus. The difference between the Wave V latency at high rate and Wave V latency at a low rate in the affected ears of all individuals with BPPV (Groups I and II) was significantly long. In the affected ears of all BPPV patients, at a high rate of ABR, the absolute latency of the Wave III was found to be significantly longer than for the control group. CONCLUSIONS: Individuals with BPPV showed prolonged latencies in affected ears in a high rate of ABR without the effect of tinnitus. High rate of ABR in individuals with BPPV can be used to obtain preliminary information in cases where ischemia in the auditory pathways is suspected in BPPV formation.

Comparison of natural ostiodilatation and endoscopic sinus surgery in the same patient with chronic sinusitis / Comparação entre a dilatação do óstio natural e a cirurgia endoscópica nasossinusal no mesmo paciente com sinusite crônica

Abstract Introduction Chronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years. Objectives To compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient. Methods Total of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund-Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis). Results There was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund-Mackay scores. However in Group 1, the results of the comparison of postoperative Lund-Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery. Conclusion The success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.

Resumo Introdução A rinossinusite crônica é uma síndrome clínica ampla, caracterizada por inflamação da mucosa nasal e seios paranasais. Para que os seios paranasais mantenham suas funções fisiológicas, as vias de drenagem do complexo ostiomeatal devem estar abertas. Os procedimentos cirúrgicos são uma importante opção de tratamento em pacientes que não respondem adequadamente ao tratamento clínico. Embora os métodos e instrumentos utilizados na cirurgia endoscópica funcional dos seios paranasais tenham melhorado continuamente, o tecido cicatricial formado durante a cirurgia interrompe a drenagem dos seios nasais e reduz o sucesso pós-operatório. O método natural de dilatação ostial, que é aplicado por meio da técnica de sinuplastia com balão, tem se tornado cada vez mais popular nos últimos anos. Objetivos Comparar a técnica de sinuplastia com balão com o método convencional de cirurgia endoscópica, no mesmo paciente, considerando a gravidade da rinossinusite crônica. Método Foram incluídos no estudo 61 pacientes com rinossinusite crônica. Por meio de tomografia dos seios paranasais e de acordo a escala de Lund-Mackay foram determinados os graus da rinossinusite crônica. Os casos foram divididos em dois grupos: Grupo 1 (grupo com rinossinusite crônica grave) e Grupo 2 (rinossinusite crônica leve). Resultados No Grupo 2 não houve diferença estatisticamente significante, segundo a escala de Lund-Mackay, no resultado da comparação dos seios paranasais nos quais foram realizadas a sinuplastia com balão e por cirurgia endoscópica convencional. No entanto, no Grupo 1, os resultados da comparação dos escores pós-operatórios de Lund-Mackay mostraram-se estatística e significativamente melhores naqueles submetidos à cirurgia endoscópica funcional dos seios paranasais. Conclusão O sucesso da sinuplastia com balão em pacientes com rinossinusite leve é o mesmo da cirurgia endoscópica funcional dos seios da face tradicional. No entanto, à medida que a gravidade da rinossinusite aumenta, a eficácia da sinuplastia com balão diminui.

Comparison of natural ostiodilatation and endoscopic sinus surgery in the same patient with chronic sinusitis.

INTRODUCTION: Chronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years. OBJECTIVES: To compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient. METHODS: Total of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund-Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis). RESULTS: There was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund-Mackay scores. However in Group 1, the results of the comparison of postoperative Lund-Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery. CONCLUSION: The success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.

Acute exudative tonsillitis in adults: the use of the Centor scoreand some laboratory tests.

BACKGROUND/AIM: The aim of our study was to determine the usefulness of the Centor score and some basic laboratory tests (complete blood count and C-reactive protein) for the differential diagnosis of exudative tonsillitis due to Group A β-hemolytic streptococcus (GABHS) or due to non-GABHS agents. MATERIALS AND METHODS: The data of clinical and laboratory characteristics of the patients diagnosed with exudative tonsillitis were collected and statistically compared between those having positive GABHS throat culture result and those who were negative for any bacterial agent. RESULTS: Totally 899 adult patients were included in our study; 56 (6.2%) of them were positive for GABHS, while 34 (3.8%) of the cases had a bacterial cause other than GABHS. The remaining 809 (90%) were accepted as non-GABHS cases. The percentages of patients having Centor score of 3 or greater, neutrophilia, lymphocytopenia, and CRP values of greater than 5-fold normal upper reference range were significantly higher in GABHS patients. CONCLUSION: Centor score of 3 or more together with high CRP, neutrophilia, and lymphocytopenia is predictive for GABHS tonsillopharyngitis.

Conchal compression: is it a new syndrome?

OBJECTIVES/HYPOTHESIS: To describe the diagnostic criteria and treatments of concha compression syndrome (CCS). PATIENTS AND METHODS: Patients who reported at least 3 times rhinosinusitis attacks per year were considered in this study. All patients met the diagnosis criteria of rhinosinusitis based on clinical history, showed a nasal septal spur compressing concha on their endoscopic examination and had no findings of rhinosinusitis on their paranasal sinus CT scans but showed concha ondularis. These patients were recognized as suffering from CCS and consequently were surgically treated. RESULTS: 85 patients diagnosed with CCS were included in this study. 25 of the patients were classified as middle, 53 as inferior and 7 as both middle and inferior CCS. Septal spur removal was performed on 16 of the patients whereas the remaining 69 patients received spur removal with septoplasty. After surgery, most of patients' symptoms improved clinically. CONCLUSION: The importance and the necessity of further investigations into this newly-defined syndrome in the differential diagnosis of rhino-neurogenic symptoms is made clear by this study.

[Submucosal lingual schwannoma]. / Dilde submukozal yerlesimli schwannom.

Schwannoma or neurilemmoma is a slow growing, solitary, and encapsulated benign tumor originating from Schwann cells of the peripheral nerves. Lingual schwannomas are rare. A 46-year-old male patient admitted with a complaint of swelling on the right half of the tongue for one year. An approximately 1x1 cm submucosal mass was detected on the right side of the tongue. The submucosal mass was totally excised under local anesthesia. Pathological examination was consistent with schwannoma. Lingual schwannomas should be considered in the differential diagnosis of tongue masses.

Mastoid antral ventilation tube; new treatment modality for reccurent otitis media with effusion and its long term results.

OBJECTIVES: To evaluate the efficiency of mastoid antral ventilation tube (MAVT) treatment in recurrent/chronic otitis media with effusion (OME). METHODS: 20 OME patients who were unsuccessfully treated with ventilation tube (VT) at least twice, who consented to MAVT and who were followed up at least three years were included in the study group. Control group comprised 10 patients who had the same characteristics and refused to undergo MAVT and underwent VT placement again. Pre-operative and post-operative otomicroscopic, hearing tests, and CT findings were compared between the groups statistically. RESULTS: MAVT was placed into 24 ears of 20 patients. In the control group, VT was placed in 13 ears of 10 patients. Postoperatively, in the study group, one tympanic membrane with adhesion and nine membranes with retraction returned to their anatomic positions after MAVT. In the control group, 2 retracted tympanic membranes returned to normal position. There was significant difference between groups in terms of mastoid aeration (P = 0.006). Post-operative pure tone threshold values and mastoid aeration findings were statistically different from preoperative conditions. CONCLUSION: This preliminary study demonstrates that MAVT may be effective in the surgical treatment of recurrent/chronic OME. However, further studies with larger patient series should be carried out.

Electrophysiologic vestibular evaluation in type 2 diabetic and prediabetic patients: Air conduction ocular and cervical vestibular evoked myogenic potentials.

OBJECTIVE: Chronically increased blood glucose levels may affect the vestibular system by damaging cells and neural structures in diabetes mellitus (DM). We aimed to search the effects of neurovascular degeneration on the vestibular system in type 2 DM and prediabetic patients by using air-conducted ocular (oVEMP) and cervical (cVEMP) vestibular evoked myogenic potentials. DESIGN: Prospective study. STUDY SAMPLE: Thirty diabetic, 30 prediabetic patients, and 31 age- and sex-matched controls having no peripheral or central vestibular disease, were enrolled. All participants were evaluated by audiovestibular tests, oVEMP, and cVEMP. RESULTS: In the diabetic group, mean values of both oVEMP and cVEMP p1, n1 latencies were significantly longer compared to the prediabetic group and the control group, whereas latencies were similar in prediabetic and the control groups. Bilateral neural dysfunction was recognized in both tests and lateralization was not seen in VEMP asymmetric ratios. In the diabetic group, prevalence of pathological p1 and n1 latencies in oVEMP were 30.4% and 37.5%, whereas they were 53.7%, 59.3% in cVEMP, respectively. p1 latencies of cVEMP and oVEMP were positively correlated with HbA1c and fasting plasma glucose level in the diabetic group. CONCLUSION: Subclinical vestibular neuropathy can be a newly defined diabetes-related complication.

Preparation and placement of cartilage island graft in tympanoplasty.

INTRODUCTION: Cartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if regularly prepared and placed. OBJECTIVE: To prepare cartilage island material and evaluate its effect on the success rate of tympanoplasty. METHODS: The medical records of 87 patients (48 males and 39 females; mean age, 27.3±11.2 years; range, 14-43 years) with chronic otitis media without cholesteatoma who underwent intact canal-wall-up tympanoplasty and revision surgery between December of 2007 and October of 2011 were retrospectively evaluated. Surgery was performed under general anesthesia via a retroauricular approach. RESULTS: The overall success rate of this technique was 93% in terms of perforation closure. No graft lateralization or displacement into the middle ear occurred. The overall average preoperative air bone gap was 37.27±12.35 dB, and the postoperative air bone gap was 27.58±9.84 dB. The mean postoperative follow-up period was 15.3 months (range: 7-21 months). CONCLUSION: If cartilage graft is properly prepared and placed, cartilage graft tympanoplasty appears to provide better success rates and hearing results.

Preparation and placement of cartilage island graft in tympanoplasty / Preparação e colocação de enxertos de cartilagem “em ilha" em timpanoplastia

Introduction: Cartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if regularly prepared and placed. Objective: To prepare cartilage island material and evaluate its effect on the success rate of tympanoplasty. Methods: The medical records of 87 patients (48 males and 39 females; mean age, 27.3 ±11.2 years; range, 14–43 years) with chronic otitis media without cholesteatoma who underwent intact canal-wall-up tympanoplasty and revision surgery between December of 2007 and October of 2011 were retrospectively evaluated. Surgery was performed under general anesthesia via a retroauricular approach. Results: The overall success rate of this technique was 93% in terms of perforation closure. No graft lateralization or displacement into the middle ear occurred. The overall average preoperative air bone gap was 37.27 ± 12.35 dB, and the postoperative air bone gap was 27.58 ± 9.84 dB. The mean postoperative follow-up period was 15.3 months (range: 7–21 months). Conclusion: If cartilage graft is properly prepared and placed, cartilage graft tympanoplasty appears to provide better success rates and hearing results. .

Introducão: A timpanoplastia de enxerto de cartilagem tem uma melhor taxa de sucesso no tratamento de otite média crónica se for preparada e colocada de forma sistemática. Objetivo: Preparar o material de enxerto de cartilagem “em ilha" e avaliar o seu impacto na taxa de sucesso da timpanoplastia. Método: Os registos médicos de 87 pacientes (48 do sexo masculino e 39 do sexo feminino; idade média 27.3 ±11.2 anos; intervalo 14–43 anos) com otite média crónica sem colesteatoma que foram submetidos a timpanoplastia de levantamento de parede do canal intacto e cirurgia de revisão entre Dezembro 2007 e Outubro 2011 foram avaliados em retrospetiva. A cirurgia foi realizada sob anestesia geral através de uma abordagem retro auricular. Resultados: A taxa de sucesso global da nossa técnica foi de 93% em termos de sutura da perfuração. Não ocorreu lateralização do enxerto nem deslocação para o ouvido médio. O intervalo aéreo-ósseo pré-operatório médio global (ABG) era de 37.27 ±12.35 dB e o ABG pós-operatório era de 27.58±9.84dB. O período médio de seguimento pós-operatório era de 15.3 meses (intervalo 7-21 meses). Conclusão: Se o enxerto de cartilagem for devidamente preparado e colocado, a Timpanoplastia de enxerto de cartilagem apresenta melhores taxas de sucesso e resultados ao nível da audição. .

Langerhans cell histiocytosis in bilateral mastoid cavity.

A 39-year-old male was admitted to our clinic with symptoms of headache, dizziness, nausea, otalgia, otorrhea, tinnitus, and hearing loss in both ears for 3 weeks. Physical examination revealed edema in the tympanic membrane and external ear canal, and pain by palpation in the mastoid area bilaterally. There was no nystagmus, and the rest of the physical examination was otherwise normal. Temporal bone high resolution computed tomography (CT) showed a lesion causing erosion in the mastoid cortex, tegmen tympani, ossicles, and in the bone covering the sigmoid sinus bilaterally. There was also erosion in the superior semicircular canal and petrous bone on the left side. Cortical mastoidectomy was performed under general anesthesia. Histopathologic examination of the tissue revealed Langerhans cell histiocytosis (LCH). In this paper a case with LCH, presenting with bilateral mastoid involvement which has been rarely reported in the literature, is discussed with the existing literature.

Temporal bone fractures: evaluation of 77 patients and a management algorithm.

BACKGROUND: We aimed to evaluate the etiologies, otolaryngological features, radiological findings, management strategies, and outcomes of temporal bone fractures. METHODS: Seventy-seven temporal bone fracture cases were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, the presence of blood otorrhea, tympanic membrane perforation, cerebrospinal fluid otorrhea, hearing loss, hemotympanum, and facial or other cranial nerve palsies, and computerized tomography reports. RESULTS: Nearly 55% of the cases were caused by traffic accidents and were predominantly male (76.6%). Otolaryngological presentations in order to frequency were early conductive hearing loss (65.8%), blood otorrhea (61.2%), hemotympanum (58.5%), tympanic membrane perforation (25.6%), facial nerve paralysis (12.3%), cerebrospinal fluid otorrhea (8.5%), and sensorineural hearing loss (5.4%). Most of the fractures were petrous (65.8%) and longitudinal type (51.2%). CONCLUSION: In this research, otolaryngological findings in order of frequency and treatment approaches were compared with literature findings and discussed in 77 temporal bone fracture cases. We formed a management algorithm for the systematic evaluation and treatment of temporal fractures.

Treatment of Pott's Puffy tumor with balloon sinuplasty: report of three cases.

Pott's Puffy tumor (PPT) is a rare entity characterized by subperiosteal abscess associated with osteomyelitis of the frontal bone. It is usually managed by surgical curettage of the osteomyelitic bone and long-term antibiotic therapy. Balloon catheter dilatation is a new technique which was recently introduced for the treatment of chronic rhinosinusitis. In this article, we present three PPT cases (two of them were secondary to endoscopic sinus surgery) who were successfully treated with balloon catheter dilatation and long-term antibiotherapy.

Papillary thyroid carcinoma with metastasis to the temporooccipital skull: a case report.

The patient was admitted to our clinic with the complaint of swelling in his left post-auricular region. The medical history revealed that he underwent thyroid surgery eight years ago and the specimen was reported as papillary thyroid carcinoma. Following required analyses, total thyroidectomy and biopsy from mastoid region were performed. Total thyroidectomy specimen was proved thyroid papillary microcarcinomas at five foci of the thyroid gland, while biopsy samples obtained from the mastoid region were reported as metastatic papillary thyroid carcinoma. The patient underwent radioactive iodine, followed by radiotherapy. In this article, we present a 61-year-old male patient with papillary thyroid carcinoma metastatic to the temporooccipital region, accompanied by multiple cranial nerve paralysis.

Tympanoplasty with island cartilage or temporalis fascia: a comparative study.

PURPOSE: To compare clinical and audiological outcomes of the type 1 tympanoplasties where conchal cartilage (island graft) and temporalis fascia were used as the graft material. PROCEDURES: In this retrospective study, the results of type 1 tympanoplasty operations (n = 50) in which cartilage and temporalis fascia were used for graft material were compared. RESULTS: Pre- and postoperative otoscopic findings of both groups were similar (p > 0.05). Preoperatively, the pure tone averages (PTAs) and hearing thresholds of the fascia and cartilage groups were similar (p > 0.05). However, postoperatively, the PTAs and air-bone gap closure were better with temporalis fascia compared to cartilage grafting (p < 0.05). On frequency-specific comparisons, the pure tone thresholds at the frequencies of 0.5, 1 and 2 kHz recovered better with temporalis fascia compared to cartilage (p < 0.05). Although the pure tone recovery was better at 4 kHz with temporalis fascia, the difference between the groups were not significantly different (p > 0.05). CONCLUSION AND MESSAGE: In conclusion, in contrast to many reports in the literature, temporalis fascia grafting seems better in our study than grafting with conchal cartilage.

Comparison of outcomes of simple polypectomy plus balloon catheter dilatation versus functional endoscopic sinus surgery in nasal polyposis: a preliminary study.

BACKGROUND: The aim of this study was to compare the outcomes of functional endoscopic sinus surgery (FESS) and simple polypectomy plus balloon catheter dilatation (BCD) in nasal polyposis. METHODS: Ten patients (six male and four female subjects) with nasal polyposis who underwent surgical treatment were included in this research. BCD was performed on one side of each patient's paranasal sinuses (after nasal polypectomy by microdebrider) while standard FESS was performed on the other side. Preoperatively, all patients were treated with oral methylprednisolone, 1 mg/kg per day, for 5 days, which was reduced and stopped on the 14th day. Pre- and postoperative endoscopic and radiological findings were compared. Endonasal endoscopic examination results were classified according to MacKay classification. Paranasal sinus computed tomography findings were evaluated according to Lund-MacKay classification. RESULTS: Pre- and postmedical treatment results of the patients were not significantly different according to MacKay classification. There was no significant difference between the results of FESS and BCD during 12-month follow-up period according to Lund-MacKay and MacKay classifications. There was significant improvement in the results obtained 1 and 12 months after FESS and BCD, respectively. The improvement was also radiologically evident. CONCLUSION: At 1 year postsurgery, polypectomy plus BCD is as effective as FESS. Longer-term studies are necessary to validate this technique.

Shall we resect the tip of manubrium mallei in tympanoplasty?

OBJECTIVES: In tympanoplasty operations if perforation is related with malleus handle, malleus handle is desepithelised. We planned this research to investigate whether the epithelial remnants remain as a result of this desepithelisation or not. METHODS: The 35 patients who were performed tympanoplasty operation were divided into two groups. In the first group which included 13 patients the tip portion of manubrium mallei were cut off without desepithelisation. In the second group which included 22 patients the tip portions of manubrium mallei were cut off after the meticulous desepithelisation. The presence of squamous epithelium was examined histopathologically on the specimens. RESULTS: Squamous epithelium was observed in 9 of the 13 non-desepithelised specimens and in 6 of 22 desepithelised specimens. CONCLUSION: In tympanoplasty operations despite careful desepithelisation, squamous epithelial remnants may remain on the malleus handle. So the tip of manubrium mallei could be resected to prevent the future development of cholesteatoma.

The role of the actinomyces in obstructive tonsillar hypertrophy and recurrent tonsillitis in pediatric population.

OBJECTIVE: To determine the prevalence of tonsillar Actinomyces in subjects with recurrent tonsillitis and those with obstructive tonsillar hypertrophy, and to determine the association between the presence of Actinomyces and tonsillar volume, and crypt abscess. SUBJECTS AND METHODS: A prospective designed cross-sectional study consisted of 90 children subjects who underwent tonsillectomy or adenotonsillectomy for recurrent tonsillitis and obstructive tonsillar hypertrophy. The subjects of recurrent tonsillitis (Group A) and obstructive tonsillar hypertrophy (Group B) were compared to the presence of Actinomyces. The relationship between the presence of Actinomyces and the presence of crypt abscess, and tonsillar volume were also compared. RESULTS: Actinomyces was found to be significantly more prominent in obstructive tonsillar hypertrophy group (61.5%) compared to recurrent tonsillitis group (26.6%) (p<0.001). Additionally, the mean tonsillar volume was significantly higher in tonsils with Actinomyces than those without (p<0.001). The histopathological study revealed that there was no significant inflammatory response to the existence of Actinomyces. CONCLUSION: According to the presented study, Actinomyces was seen more prominent in subjects with obstructive tonsillar hypertrophy compared those with recurrent tonsillitis. Furthermore Actinomyces had a pathological influence on tonsil size. This study showed there was a significant relation between Actinomyces and enlargement of tonsillar tissue. However, how causes tonsillar hypertrophy is not understood yet in tonsillar disease.