A huge Thornwaldt's cyst causing hearing loss in an adult patient.

Nasopharynx (NP) is anatomically difficult to explore adequately. The pharyngeal bursa (PB) is a recess lined with respiratory epithelium along the posterior wall of the nasopharynx between the longus capitis muscles. If the opening through which the bursa drains into the nasopharynx becomes obstructed, a Thornwaldt's cyst (TC) might develop. Small-sized cysts are mostly asymptomatic, whereas large-sized cysts may lead to various nasal and otologic symptoms depending on their localization. In this report, we present a 71-year-old case with a huge TC who presented to our clinic with the complaints of snoring, nasal obstruction, periodic halitosis, postnasal drip, headache, and hearing loss in the left ear and underwent total excision of the cyst through transnasal endoscopy. The diagnosis and treatment characteristics of the case are presented with the review of the literature.

Suppurative Cervical Tuberculous Lymphadenitis Mimicking a Metastatic Neck Mass.

Tuberculosis is an important public's health problem in developing countries. Although tuberculosis is commonly found in lungs, it could also be found in lymph nodes, mouth, tonsils, tounge, nose, epiglottis, larynx, and pharynx of head-neck region. The most common form of extrapulmonary tuberculosis placed outside the lungs is tuberculous lymphadenitis. Tuberculosis lymphadenitis is the most commonly seen form of the extrapulmoner tuberculosis and usually invades the lymph nodules of the cervical region. An adult patient with tuberculous lymphadenitis has been presented within the context of the literature reviewed. A 42-year-old woman, who has admitted to our clinic with a fistulized mass in the right side of her neck, has been diagnosed and treatment has been performed. No other problems were found in the systemic examination of the patient. Since there is no specific finding of pulmonary tuberculosis, detailed investigations are required in patients admitted with the sypmtomps of neck mass.

A Thyroglossal Cyst With Double Duct Seen in an Adult Patient.

Thyroglossal duct cysts (TDCs) are one of the most common congenital cervical masses that develop in children. Double TDCs are reported in very few patients in the literature. However, the authors did not come across any thyroglossal cyst with double duct in the English literature. A 35-year female patient consulted to authors' clinic with complaints of a swelling localized on the left side of the neck and recurrent purulent discharge. A Sistrunk operation was planned and during the operation, 2 fistula tracts, both terminated in the hyoid bone, were exposed.Usually, only one fistulous tract opens onto the skin; however, in the authors' patient, the authors encountered TDC with double ducti. To authors' knowledge, no similar patients were reported in the literature.

Reattachment of a partially amputated ear without microsurgery.

Traumatic ear amputations are relatively rare. Whenever possible, ear re-implantation should be attempted; however the choice of the surgical procedure must be judicious. In the current report, a case of complete non-microsurgical salvage of a partially amputated ear treated by the pocket technique described by Mladick was presented. The surgical technique is described in detail by serial photographs, along with the postoperative management and outcome of the patients. The revascularisation of the severed part was successful. Morphological result was very good when the ear was freed from the pocket. We recommend the Mladick's procedure for reimplantation of fragments less than 1/2 of the auricle with favourable tissue condition.

Oval Window Temperature Changes in an Endoscopic Stapedectomy.

OBJECTIVES: Following the initial use of endoscopes in otology, the pros and cons of these instruments have been questioned increasingly. These instruments cause an increase in temperature that needs to be investigated. In this study, the authors aimed to investigate the temperature increase caused by endoscopes and light sources in the perilymph by performing a stapedotomy in an animal model under anesthesia. STUDY DESIGN: The study was performed in a guinea pig model. METHODS: In the animal model, a simulated otologic stapes surgery was performed at room temperature. The body temperatures of the guinea pigs were monitored; the temperature increase caused by the 0-degree rigid endoscopes with diameters of 3 and 4  mm as well as the light sources, including halogen, light-emitting diode (LED), and xenon lamps, were monitored following the stapedotomy to measure and document the continuous temperature increase in the perilymph using sensors placed at the oval window. RESULTS: Rigid endoscopes cause a temperature increase in the tympanum regardless of their diameter when used with xenon and halogen light sources. The LED light caused a relatively small temperature increase. CONCLUSIONS: The endoscopic instruments used in the stapes operation caused a temperature increase in the oval window. The authors concluded that this heat could easily be transmitted to the cochlea by the perilymph, which has obstructed contact with the outer environment following stapedomy, resulting in neurosensorial damage.

Primary localised laryngeal amyloidosis.

Localised amyloidosis of the larynx is uncommon and poorly understood. The precise etiology and pathogenesis are not entirely clear. It usually presents with hoarseness, pain and/or difficulty in breathing. We present the case of a 42-year-old woman with primary localised laryngeal amyloidosis who presented with hoarseness and dyspnoea. Biopsy of the specimen revealed amyloid.There were no signs of any systemic disease in the patient and diagnosis was established histopathologically. She was treated surgically by microlaryngoscopy under general anaesthesia. At 6 months, the patient's voice and breathing had both improved substantially.

Masked subdural empyema secondary to frontal sinusitis.

Intracranial complications of pediatric sinusitis are rare but potentially life threatening. These complications include cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema. Children with these complications may experience significant morbidity from their infection. In such cases, delay in diagnosis and treatment may lead to severe brain damage or death. Emergency physicians, pediatricians, and otolaryngologists should maintain a high index of suspicion for this complication of disease when treating patients with sinusitis in the emergency department or outpatient clinic. Early and accurate diagnosis of subdural empyema will lead to prompt treatment and a favorable outcome for the patient. We report a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy immunocompetent adolescent boy.

The effect of extracorporeal shock wave lithotripsy on the hearing.

OBJECTIVE: To investigate the effects of extracorporeal shockwave lithotripsy on hearing. METHODS: The study group consisted of 34 patients with urinary lithiasis on whom ESWL was applied in a single course. Patients with normal hearing levels were included in the study. Conventional audiometry and transient evoked otoacoustic emissions were recorded before the application of the procedure and thirty minutes afterwards. RESULTS: A total of 68 ears of 34 patients were evaluated. Of those, 15 (44.1%) patients were male and 19 (55.9%) were female. The average age was 31.47 +/- 15.62 (range, 10-62 years). There was no statistically significant variation, according to the data obtained from the pure tone average threshold of the shockwave procedure on the otoacoustic emission test. CONCLUSION: The results of the study indicate that the risk to the hearing of patients exposed to lithotripter noise is negligible and, therefore, ESWL is a safe procedure.

Treatment of Large Tympanic Membrane Perforations: Medial to Malleus Versus Lateral to Malleus.

The perforation size affects the success of tympanic membrane (TM) reconstruction, in addition to the surgical technique used. Large TM perforations present a surgical challenge. The perforation size has been reported to be a prognostic factor, and poorer results are obtained with large versus small perforations. We aimed to evaluate patients who had undergone tympanoplasty for large perforations at our clinic using either the underlay or over-underlay technique and to compare the results in terms of re-perforation, retraction, lateralization, and improvement of hearing. Of 302 patients with chronic otitis media, 114 who had a perforation that involved over 50 % of the pars tensa were enrolled in the study. The underlay technique was used in 61 patients, and the over-underlay technique in 53 patients. In the underlay group, the preoperative mean perforation size was 30.11 ± 5.35 mm(2) (range 20.00-52.00 mm(2)) (n = 61). In the over-underlay group, the preoperative mean perforation size was 31.41 ± 8.65 mm(2) (range 22.00-48.00 mm(2)) (n = 53). The graft success rate of tympanoplasty performed using the underlay technique was 89.1 % in 61 patients. Seven (10.9 %) patients had graft failure. The graft success rate with the over-underlay technique in 53 patients was 90.5 %. Five (9.5 %) patients had graft failure in this group. Three graft lateralizations (5.6 %) and two retractions (3.8 %) were observed at 12 months postoperatively in the over-underlay group. However, in the underlay group, no graft lateralization but five retractions (8.2 %) were observed at 12 months. The graft-take rates and hearing improvement results in both groups were successful and compatible with those in the literature.

Traumatic fronto-ethmoidal encephalocele: a rare case.

Encephalocele is defined as herniation of the brain tissue from a bone defect in the cranium. It may be congenital, traumatic, tumoural or develop spontaneously. Traumatic fronto-ethmoidal encephalocele is rare and should be kept in mind for patients who have suffered trauma. Early diagnosis is important in terms of preventing life-threatening complications such as meningitis. Encephalocele and cerebrospinal fluid (CSF) leakage can be easily determined with basic radiological imaging methods and clinical findings. The computed tomography (CT) and magnetic resonance imaging (MRI) findings are here presented of a case with traumatic encephalocele.

Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps.

OBJECTIVE: Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs. METHODS: One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n=60) consisted of patients with NPs, and group 2 (n=60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels. RESULTS: There were no statistical differences in gender, age and biochemical values between two groups (p>0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p<0.001). CONCLUSION: As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.

The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy.

OBJECTIVE: To evaluate the efficacy of Ankaferd Blood Stopper (ABS) in the control of intraoperative and postoperative bleeding in adenoidectomy. METHODS: In total, 90 patients underwent traditional cold steel adenoidectomy and were then randomized to receive ABS or 0.9% physiological saline solution to obtain hemostasis. Objective data collected included time of operation and blood loss during operation. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal and ease of operation. RESULTS: In a comparison between patients in the ABS group (n = 46) and the control group (n = 44), those in the ABS group had significantly shorter operation times (9.11 ± 1.02 vs. 13.16 ± 3.96 min; p < 0.001) and less blood loss during the operation (20.19 ± 8.59 vs. 25.48 ± 12.96 ml; p ≤ 0.05) and a shorter hemostasis time (3.83 ± 0.8 vs. 5.82 ± 1.67 min; p < 0.001). Regarding hemorrhage after tampon removal, 40 patients (87%) in the ABS group and 17 patients (38.6%) in the control group did not suffer from hemorrhage (p < 0.001). Regarding ease of hemostasis, 40 patients (87%) in the ABS group experienced very easy or easy hemostasis while 26 patients in the control group did so (59.1%; p = 0.004). Patients in the ABS group returned to a regular diet earlier and had less use of analgesics at 7 days postoperatively. Use of electrocautery was less in the ABS group than in the control group (10.9 vs. 40.9%; p = 0.001). CONCLUSIONS: The side on which ABS was used showed significant differences in hemostasis time, blood loss, and ease of hemostasis. ABS appears to be safe and effective; it decreases intraoperative bleeding and reduces operating time when compared to traditional hemostasis methods after curette adenoidectomy.

Primary hydatid cyst: an unusual cause of a mass in the supraclavicular region of the neck.

UNLABELLED: Hydatid disease, also known as echinococcosis or hydatidosis, is an infectious disease caused by the cestode Echinococcus. Echinococcus granulosus is the most common Echinococcus species affecting human beings. It may affect any organ and tissue in the body, in particular the liver and lung. Musculoskeletal or soft tissue hydatidosis accounts for about 0.5% 5% of all echinococcal infections in endemic areas, and is almost always secondary to the hepatic or pulmonary disease. Even in regions where echinococcosis is endemic, hydatidosis of cervicofacial region is extremely rare. Herein, we present exceptionally rare case with an unusual localization of primary hydatid cyst in the left supraclavicular region of the neck. KEYWORDS: Hydatid cyst; Supraclavicular region; Neck; Unusual localization.