The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response.

The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis.

An evaluation of the results of chemoradiotherapy and surgical treatment for hypopharyngeal cancer.

OBJECTIVES: This study aims to evaluate the efficacy chemoradiotherapy and surgical treatment in patients with hypopharyngeal cancer. PATIENTS AND METHODS: Between January 2003 and July 2009, 48 patients (31 males, 17 females; mean age 55.5±13.4 years; range 29 to 84 years) who were diagnosed with hypopharyngeal cancer were retrospectively evaluated. The patients were assigned into surgery (n=17) and chemoradiotherapy (n=31) groups. RESULTS: The overall survival of the patients with advanced disease in the surgery group was statistically higher than those in the chemoradiotherapy group. The recurrence rate of the patients was 35.3% in the surgery group, whereas it was 41.4% in the chemoradiotherapy group. CONCLUSION: Our study results indicated that the survival rates were higher in the surgery group. On the other hand, chemoradiotherapy had the advantage of laryngeal preservation.

Efficacy of radiofrequency turbinate reduction: evaluation by computed tomography and acoustic rhinometry.

BACKGROUND: Radiofrequency ablation (RFA) of the inferior turbinates is a popular surgical intervention that aims to reduce turbinate volume. However, in a few studies, the amount of volume loss was analyzed objectively. OBJECTIVE: The aim of this study was to investigate the effects of RFA on the inferior turbinate by comparing its volume before and 6 weeks after surgery via computed tomography (CT) and the change in minimal cross-sectional areas (MCAs) via acoustic rhinometry objectively. METHODS: Eighteen patients who underwent RFA with the diagnosis of isolated bilateral inferior turbinate hypertrophy were enrolled in the study. All patients were evaluated pre- and postoperatively with paranasal CT and acoustic rhinometry quantitatively for the assessment of inferior turbinate volume decrement and nasal cavity volume increment. Also, the subjective relief of obstructive symptoms was assessed with a visual analogue scale. RESULTS: There were significant reductions in volume for both right and left turbinates in the tomographic evaluation (p  =  .007 and .004, respectively). Acoustic rhinometry revealed nonsignificant increments for both MCA1 and MCA2 values except MCA2 of the right side. We also indicated a statistically significant correlation between the mean volume reduction in CT and improvement in mean MCA2 volume (2 to 5 cm from the nostril) obtained from acoustic rhinometric data in 36 turbinates (r  =  .337, p  =  .044). CONCLUSION: We showed that the use of RFA was highly effective in both reducing turbinate volume (demonstrated by radiologic findings and rhinometric analysis) and improving obstructive symptoms in patients with an isolated inferior turbinate.

The efficacy of nasal surgery in obstructive sleep apnea syndrome: a prospective clinical study.

The aim of this study was to investigate the effects of surgical intervention for nasal pathologies on obstructive sleep apnea syndrome (OSAS) and continuous positive airway pressure (CPAP) titrations in patients with OSAS. The study was designed as a prospective case control study. Between December 2007 and June 2010, 31 patients (26 men and 5 women) who were diagnosed with OSAS with polysomnography and confirmed to have obstructive nasal pathology were enrolled in the study. The average age of the patients was 53 ± 9.6 (range 33-68 years) and the body mass index ranged from 22 to 40.6 kg/m(2) with an average of 30.3 ± 4.1. The patients were evaluated with Epworth Sleepiness Scale, OSAS Complaints Questionnaire, visual analog scale, and CPAP titration before and 3 months after nasal surgery. As three patients did not attend the control polysomnography, data analysis was performed on 28 patients. Although there was a significant improvement in the nasal passage and subjective complaints, namely, snoring frequency, apnea and daytime sleepiness, the difference between preoperative and postoperative AHI values was not statistically significant. Postoperative CPAP titration results indicated a decrease both in pressures and in AHI in comparison to preoperative values. These reductions were not statistically significant, although the decrease in CPAP pressures was close to significance (p = 0.062). Nasal pathologies should be treated in all patients with OSAS, particularly those undergoing CPAP treatment. However, patients should be counseled that favorable results might not be achieved after nasal surgery.

The role of selective neck dissection in pathological N1 squamous cell carcinomas of the head and neck.

OBJECTIVES: This study aims to evaluate the effectiveness of selective neck dissection (SND) in stage pN1 head and neck cancers. PATIENTS AND METHODS: Patients who underwent neck dissection due to squamous cell carcinoma of oral cavity, larynx, oro-hypopharynx were evaluated retrospectively. Sixty-one patients diagnosed with pathological N1 by neck dissection were included in the study. Thirty-four of the 61 necks, to which SND was applied, comprised the study group, and 27 necks, which underwent comprehensive neck dissection (CND), comprised the control group. RESULTS: Neck recurrence rates were 4.9% for all cases, 5.9% for the SND group and 3.7% for the CND group. Two- and five-year disease-specific survival rates were similar for SND group (78.6%, 72.5%) and CND group (90.5%, 82.9%). Two- and five-year overall survival rates were also similar for SND group (67.6%, 58%) and CND group (81.5%, 66%). None of them were significantly different between groups (p>0.05). CONCLUSION: Selective neck dissection provides comparable results to CND in the treatment of pN1 necks.

[The effect of treatment of temporalis muscle fascia grafts with formaldehyde on the success rates of tympanoplasty]. / Temporal kas fasya greftlerinin formaldehit ile islenmesinin timpanoplasti basari oranlarina etkisi.

OBJECTIVES: This study aims to investigate the effect of formaldehyde treatment of temporalis muscle fascia grafts used during tympanoplasty on the postoperative success rates. PATIENTS AND METHODS: Fifty-four patients who underwent tympanoplasty between January 2006 and January 2007 in the Department of Otolaryngology, Medicine Faculty of Uludag University and who were under regular follow-up were included in this prospectively planned study and divided into two groups: the study group (n=24) and the control group (n=30). Temporal muscle fascia grafts were used in all patients. The grafts were treated with formaldehyde in the study group. All the controls of the patients were performed by otomicroscopy. Audiometric tests were performed at the 6th month controls. RESULTS: It was found out that perforation was permanently repaired in 79.2% of the study group and in 73.3% of the control group (p>0.05). We obtained an evident improvement in the average airway bone gap in both groups. We could not detect any statistical significance in the comparison of the operation duration between the groups although the operation duration in the study group was shorter (the study group: 735 seconds, the control group: 775 seconds). CONCLUSION: The formaldehyde treatment of the temporalis muscle fascial graft used in tympanoplasty was not superior in closing perforation and operation length compared to its direct dry use. However, we concluded that the graft could be more easily manipulated during the operation.

The reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome.

OBJECTIVES: This study aims to assess the reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Seventy-two patients (50 males, 22 females; mean age 51.4±11.1 years; range 20 to 74 years) with OSAS were included in this prospective, non-randomized double-blinded single cohort study between May 2008 and February 2009. Patients who underwent an attended overnight polysomnography (PSG) and consented to participate in the study were asked to use SleepStrip device within the week following PSG recording. The apnea-hypopnea index (AHI) was compared with the SleepStrip score (Sscore). RESULTS: The mean body mass index of patients was 31.1±4.3. Both AHI and Sscore were obtained in 64 patients. There was a strong correlation between Sscore and AHI (r=0.76, p<0.001). The sensitivity and specificity of the SleepStrip were 94.4% and 93.5% when used to diagnose cases with AHI = or >40. The sensitivity and specificity of the SleepStrip was reduced to 80% and 87.2% when AHI threshold was chosen as = or >25 and 83.3% and 76.5% for AHI = or >15 respectively. CONCLUSION: There is a strong correlation between SleepStrip and AHI. SleepStrip was found to be effective in diagnosing severe OSAS with AHI = or >40, however, its diagnostic capability was reduced in patients with lower AHI's who constitute the main target of screening.

Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: placebo-controlled clinical study.

OBJECTIVES: To compare the effects of preincisional peritonsillar infiltration of levobupivacaine and bupivacaine on post-tonsillectomy pain in children. METHODS: Sixty children undergoing elective tonsillectomy or adenotonsillectomy were randomly allocated into three groups before tonsillectomy: peritonsillar infiltrations with 0.25% levobupivacaine with 1:200,000 epinephrine (group levobupivacaine, n=20), 0.25% bupivacaine with 1:200,000 epinephrine (group bupivacaine, n=20), and normal saline (group saline, n=20) were applied. Pain was evaluated by using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS). Choice of additional analgesic was acetaminophen for all patients. RESULTS: mCHEOPS values at 0th (immediately) and 30th minute after arrival the PACU were lower in both the local anesthetics groups than the saline group (p<0.001, p<0.01 for the group levobupivacaine; p<0.001, p<0.05 for the group bupivacaine, respectively). In addition, mCHEOPS values at 1st hour in the ward was lower in the group bupivacaine when compared to the group saline (p<0.05). Analgesic requirements and the time to first analgesia required, were also significantly different between the local anesthetic and saline groups (p<0.05 for both local anesthetics groups). Time to first mobilization was shorter in both local anesthetic groups when compared to the saline group (p<0.05 for both local anesthetic groups). CONCLUSION: Preincisional peritonsillar infiltration with levobupivacaine or bupivacaine before tonsillectomy, are effective than saline, in reducing early post-tonsillectomy pain, where as bupivacaine had slightly longer effect. Compared to saline, with both anesthetic infiltrations, lesser medication for analgesia is required. The clinical trial registration number (Research Ethics Committee of Medical Faculty, Uludag University): 2008-4/36, 19 February 2008.

Unexpected findings in the neck dissection specimens for primary head and neck squamous cell carcinoma.

OBJECTIVES: We aimed to determine the incidence of unexpected pathological findings observed during the histopathological examination of the neck dissection specimens performed for primary head and neck squamous cell carcinoma, and their impacts on the treatment and follow-up plans. PATIENTS AND METHODS: We retrospectively reviewed 410 patients (369 males, 41 females; 169 patients unilateral, 241 patients bilateral) with a diagnosis of squamous cell carcinoma of head and neck, who underwent 651 neck dissections. RESULTS: Unexpected pathological findings were found in 3.2% of patients and 2% of neck dissections. These unexpected findings were tuberculosis in eight patients (2%), metastatic papillary thyroid carcinoma in three patients (0.7%), Warthin,s tumor in one patient and cystic hygroma in one patient. All patients who had metastatic papillary thyroid carcinoma received radioactive iodine treatment after thyroidectomy. In control examinations, none of these cases had problem related to neither primary disease nor thyroid pathology. Only two of eight patients who had tuberculosis in lymph nodes received medical treatment for tuberculosis, while the others were observed by clinical and radiological examinations. None of these patients had problems related to tuberculosis. We had no long-term follow-up results for cystic hygroma and Warthin,s tumor since these patients did not continue their routine examinations. CONCLUSION: During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. Most frequently seen unexpected findings were tuberculosis lymphadenitis and metastatic papillary thyroid carcinoma. However, these pathologic findings do not seem to affect the management of the primary disease.

Preoperative evaluation of chronic rhinosinusitis patients by conventional radiographies, computed tomography and nasal endoscopy.

OBJECTIVES: The aim of this study was to compare the efficacy of conventional radiography (CR), computed tomography (CT) and nasal endoscopy for the preoperative evaluation of chronic rhinosinusitis in patients with persistent complaints despite appropriate medical therapy. PATIENTS AND METHODS: Forty-three patients (26 males, 17 females; mean age 43 years; range 15 to 73 years) were prospectively evaluated. All patients underwent detailed physical examination, CR and coronal high resolution CT of paranasal sinuses. Thirty of them were evaluated with detailed nasal rigid and/or flexible endoscopy as well. The anatomic variations and mucosal changes in paranasal sinuses were noted. The specificity and sensitivity of CR was calculated using CT findings as a reference point. Surgery was performed on two of the other three patients because of obstructive symptoms of middle turbinate. Paradoxal middle turbinate surgery was performed on one patient due to a headache of rhinogenic origin. RESULTS: In our study 40 (93%) of all patients showed mucosal abnormalities on CT. Computed tomography scanning of the patients revealed anatomic variations in 74.4% of the cases. Mucosal pathology was most frequently observed in the anterior ethmoid region (middle meatus). While we found mucosal anomalies in 47.4% of all sinuses using CR, 42.2% of these cases were confirmed with CT. Also, 19.5% of all sinuses evaluated as normal with CR presented pathologic findings on CT. An overall correlation of 75.3% was observed between CR and CT, while diagnostic nasal endoscopy and CT findings were correlated at a rate of 87%. CONCLUSION: (i) While no ipsilateral maxillary or frontal sinus disease was detected when no abnormality in the anterior ethmoid region and infundibulum was observed endoscopically in the presence of mucosal abnormalities similar abnormalities were seen at the same side for maxillary or frontal sinuses. (ii) Anatomic variations of nasal and paranasal sinuses may be considered as etiologic and predisposing factors of chronic rhinosinusitis. (iii) Conventional radiography should not be used as a single diagnostic tool in preoperative evaluation; however, due to its high sensitivity, CR technique may be used alone in the diagnosis and follow-up of maxillary sinus disease. (iv) Nasal endoscopy may reduce unnecessary diagnostic CT scanning procedures.

Evaluation of amylase levels in the neck drainage and serum for early diagnosis of the pharyngocutaneous fistula.

OBJECTIVES: To assess the value of amylase levels in neck drainage and serum for the diagnosis of pharyngocutaneous fistula in the early postoperative period. PATIENTS AND METHODS: We conducted a prospective study in a tertiary referral setting. Thirty-two patients (31 males, 1 female; mean age 63; range 45 to 75 years) who had laryngectomy operation as the primary treatment were studied. Amylase levels in the neck drainage and serum were analyzed in the first three postoperative days. The results were compared between patients who developed pharyngocutaneous fistula and who did not. RESULTS: Serum amylase levels were significantly higher in pharyngocutaneous fistula group, whereas amylase in the neck drainage was not diagnostic. CONCLUSION: Serum amylase levels may be used in laryngectomy patients for the early diagnosis of pharyngocutaneous fistula.

Accessory nerve function after level 2b-preserving selective neck dissection.

BACKGROUND: The aim of this prospective study was to evaluate the relationship between accessory nerve functions and level 2b-preserving selective neck dissection. METHODS: Forty-one necks of 30 patients with laryngeal cancer who underwent unilateral or bilateral level 2b-preserving neck dissections, between February 2003 and July 2005, were evaluated. Neck and shoulder movements and muscle strengths were examined and electroneuromyography (ENMG) was performed preoperatively at the postoperative 21st day and 6th month. Pathological anatomical findings at the postoperative 6th month were also evaluated. RESULTS: All shoulder movements and muscle strengths were preserved. Neck extension, rotation movements, and flexion strengths were restricted. ENMG values were affected moderately in the early postoperative period and improved slightly in the late postoperative period. None of the patients developed shoulder syndrome or adhesive capsulitis. CONCLUSION: Preserving level 2b during selective neck dissection decreases trauma to the accessory nerve and improves functional results.

Hypothyroidism after primary surgical treatment for laryngeal and hypopharyngeal cancer.

OBJECTIVES: We investigated the incidence of hypothyroidism after treatment of laryngeal or hypopharyngeal cancer (LHC), and evaluated its relationship with treatment modalities. PATIENTS AND METHODS: Thyroid functions of 42 patients (41 males, 1 female; mean age 58 years; range 35 to 81 years) undergoing surgical treatment with (74%) or without adjuvant radiotherapy for LHC were prospectively evaluated preoperatively, on the 15th day, and in the sixth month postoperatively. The results were compared in relation to the treatment methods employed. RESULTS: The overall incidence of post-treatment hypothyroidism was 23.8%. Five patients had hypothyroidism in the early postoperative period, and this number increased to 10 after six months. All patients with hypothyroidism had undergone total laryngectomy with bilateral neck dissection, followed by radiotherapy. A significantly higher incidence of hypothyroidism was associated with total laryngectomy, bilateral neck dissection, level VI dissection, partial or bilateral thyroidectomy, adjuvant radiotherapy, and upper mediastinal radiotherapy. CONCLUSION: The incidence of post-treatment hypothyroidism is not rare in LHC patients, requiring long-term monitoring of thyroid functions to prevent associated morbidities.

Neurological and neurophysiological effects of oral isotretinoin: a prospective investigation using auditory and visual evoked potentials.

Over the last decade, accumulating evidence has indicated that retinoids may be capable of affecting the development, differentiation and function of nervous tissue. The purpose of the present study was to investigate whether oral isotretinoin can affect brainstem and cortical sensorial activities. We performed neurological and neurophysiological studies (brainstem auditory and visual evoked potentials) in 32 patients with various skin diseases receiving isotretinoin. A significant increase of the third (L(III)) and fifth peak latency (L(V)) in left and right ear (p = 0.03, p = 0.02 for L(III), p = 0.03, p = 0.04 for L(V) respectively), and a significant increase in the latency of wave one and interpeak latency (IPL) I-V in the left ear were found after isotretinoin administration, as compared to the pretreatment (p = 0.0036 and p = 0.02, respectively). No significant differences of other latencies, IPLs and the value of visual evoked potential P-100 implicit time were observed. However, a marked increase in latency P-100 wave was found in 6 patients after therapy. It seems reasonable to suggest that neurophysiological and neurological evaluation of audiological and ocular nerve (or retinal) function may be added to the list of investigations that are performed in patients treated with oral isotretinoin.

Low-grade urinary albumin excretion in normotensive/non-diabetic obstructive sleep apnea patients.

Previous studies have indicated that high levels of urinary albumin excretion (UAE) are associated with an increased incidence of cardiovascular morbidity and mortality. This study examined the association between UAE and obstructive sleep apnea syndrome (OSAS). The study included 35 newly diagnosed OSAS patients and 11 nonapneic controls. Subjects with diabetes mellitus, hypertension, a history of renal failure, cardiac failure, coronary heart disease, collagen tissue disease, high serum creatinine, and urinary infection, and who use angiotensin-converting enzyme inhibitors and were women were excluded from the study. A single void morning urine sample at the baseline examination was used to measure UAE. There were no significant differences in the age, body mass index (BMI), and smoking habits of the OSAS patients and controls. UAE of the OSAS group was significantly higher than that of the control group (23.3 +/- 6.1 microg/min vs. 6.5 +/- 2.1 microg/min, respectively; P = 0.002). UAE was positively correlated to length of time spent at an oxygen saturation of <90% (r = 0.503, P = 0.002) and BMI (r = 0.361, P = 0.033). Regression analyses (r (2) = 0.504, P < 0.0001) showed that the length of time spent at an oxygen saturation of <90% (P < 0.0001) was risk factor for UAE, independent of age and BMI. Our study supports the notion that low-grade UAE is associated with non-hypertensive/non-diabetic OSAS, independent of age and BMI. Low-grade UAE may be a marker for subclinical vascular damage that predisposes OSAS patients to future cardiovascular disease.

Relief from sleep apnea after radiation and chemotherapy.

Superior vena cava syndrome (SVCS) can result from extrinsic compression by a primary tumor, mediastinal lymph nodes metastases, benign lesions, or intraluminal thrombosis. The association between obstructive sleep apnea and SVCS has not been extensively evaluated. To our knowledge, only 5 cases of obstructive sleep apnea in SVCS have been reported in the literature. We presented a 53-year-old man who was admitted with dyspnea, edema of the face, and excessive daytime sleepiness. Chest radiography and computed tomography revealed lung cancer. A biopsy of the tumor revealed squamous cell carcinoma. Obstructive sleep apnea was diagnosed by polysomnography (apnea hypopnea index: 13 per hour). After radiation and chemotherapy, edema of the face, snoring, and daytime sleepiness were alleviated, and the patient's apnea hypopnea index decreased to 0.6 per hour. In conclusion, there is a relationship between obstructive sleep apnea and SVCS.

Shoulder function after accessory nerve-sparing neck dissections.

BACKGROUND: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. METHODS: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. RESULTS: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. CONCLUSIONS: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.

Basaloid squamous cell carcinoma of the larynx: a report of four new cases.

OBJECTIVES: This study is designed to report the clinical and pathologic features and outcome of cases of basaloid squamous cell carcinoma (BSCC) of the larynx treated in our clinic. STUDY DESIGN: A retrospective review of the medical records of these patients. METHODS: Four cases of BSCC of the larynx were treated in our department. Histopathologic slides were reevaluated to confirm the diagnosis. Immunohistochemical studies were performed, and file records were reviewed. Follow-up was available for all patients and ranged between 11 and 72 (mean 37) months. RESULTS: All patients were male (mean 57), with supraglottic or transglottic larynx tumors. Two patients presented with stage-II disease and the other 2 with stage-IV disease. Initial diagnosis was invasive squamous cell carcinoma in 3 patients and BSCC in one patient. Two patients who had stage-II disease underwent partial laryngectomy and bilateral neck dissections; total laryngectomy and bilateral neck dissections were performed in stage-IV patients. Three patients received adjuvant postoperative radiotherapy, and 2 of them also received additional chemotherapy. Patients with stage-IV disease were found to have 4 and 27 metastatic lymph nodes on histopathologic examination and died because of distant metastases at 11 and 14 months, respectively. Patients with stage-II disease did not have cervical metastasis on histopathologic examination and were alive and free of disease at 52 and 72 months respectively. CONCLUSION: In contrast with the literature reporting the tendency of more aggressive clinical behavior of the BSCC, we can say that BSCC has a behavior similar to conventional squamous cell carcinoma based on our 4 cases.

[The management of pharyngocutaneous fistulas after total laryngectomy and the factors affecting their incidence]. / Total larenjektomi sonrasi farengokutanöz fistül gelisimini etkileyen faktörler ve fistül tedavisine yaklasimimiz.

OBJECTIVES: This study sought to determine the incidence and etiologic factors of pharyngocutaneous fistulas occurring after total laryngectomy. PATIENTS AND METHODS: A total of 138 patients (136 males, 2 females; mean age 59.5 years; range 36 to 83 years) underwent total laryngectomy for squamous cell carcinoma. Risk factors and the management of pharyngocutaneous fistulas were assessed together with durations in relation to fistula occurrence, oral feeding, hospitalization, and healing. RESULTS: Pharyngocutaneous fistulas were seen in 37 patients (26.8%). Significantly high rates of fistula occurrence were detected in patients with alcohol consumption (p=0.032), and in those who underwent partial pharyngectomy (p=0.058) or bilateral neck dissection (p=0.049) along with total laryngectomy. The occurrence of fistulas was significantly associated with prolonged lengths of time for oral feeding and hospital stay (p<0.001). Fistulas were repaired surgically in 24.3% of patients, in whom the time to oral feeding was significantly shorter than that of patients who received local wound care (p=0.03). CONCLUSION: Our data show that early surgical intervention is more beneficial in preventing further morbidity associated with pharyngocutaneous fistulas.

[The incidence of hyperinsulinemia in patients with tinnitus and the effect of a diabetic diet on tinnitus]. / Tinnituslu hastalarda hiperinsülinemi sikligi ve diyabet diyetinin tinnitus üzerine etkisi.

OBJECTIVES: We investigated the incidence of hyperinsulinemia in patients presenting with tinnitus and evaluated the effect of diabetic diet on tinnitus. PATIENTS AND METHODS: Serum insulin levels were measured and oral glucose tolerance test was performed in 52 patients (26 males, 26 females; mean age 50 years; range 20 to 80 years) with idiopathic tinnitus. Those with hyperinsulinemia were given a diabetic diet for four months. A questionnaire was administered to all the patients and the complaint of tinnitus was assessed according to a rating scale before and after treatment. The results were compared with those of 15 age-and sex-matched controls. RESULTS: Hyperinsulinemia was detected in 76% and 27% of the patients and the controls, respectively (p<0.05). Oral glucose tolerance test was normal in 48% of the patients, and in 80% of the controls (p<0.05). Following a diabetic diet, the severity of tinnitus complaints significantly decreased in patients with hyperinsulinemia (p<0.0001). CONCLUSION: Hyperinsulinemia may play an etiologic role in tinnitus and a diabetic diet may result in significant improvement in tinnitus complaints in this population.