Late effects of medulloblastoma treatment: multidisciplinary approach of survivors.

PURPOSE: Medulloblastoma is one of the brain tumors with increased life expectancy due to improvements in treatment approaches. Besides the promising results, various undesirable effects can be encountered. This study's aim is to review long-term follow-up outcomes of our cases with medulloblastoma. METHODS: Age at diagnosis, histological type of medulloblastoma, resection extension, chemotherapy and radiotherapy schemes, follow-up duration, and endocrinological, neuropsychiatric, cardiological, auditory, and visual examination results were evaluated in 20 patients diagnosed between 2007 and 2018 and followed 5 years and more. RESULTS: Twenty of 53 patients were included to the study. Eleven (55%) were male. Mean age at diagnosis was 6.95 years; mean age at the time of the study was 14 years. Mean follow-up time was 8.95 years. In terms of surgery, 14 (70%) were gross total, 1 (5%) was near total, and 2 (10%) were subtotal resection. In histopathological examination, 14 (70%) were classical medulloblastoma, 4 (20%) were desmoplastic medulloblastoma, and 1 (5%) was anaplastic medulloblastoma. With regard to endocrinological evaluation, 15 (75%) patients had hypothyroidism, 5 (25%) had growth hormone deficiency, 7 (35%) had clinical growth hormone deficiency, and 5 (25%) had sex hormone disorders. In neuropsychiatric examination, 11 (55%) patients had neurological sequelae, 18 (90%) patients had psychiatric issues, and 14 (70%) patients had two or more neuropsychiatric problems simultaneously. One (5%) patient had mitral valve insufficiency. Twelve patients (60%) had hearing loss. According to visual examination, 6 (30%) patients had refraction problem, 4 (20%) had cataract, and 1 (5%) had dry eye. CONCLUSION: Careful monitoring of long-term side effects is important for improving the quality of life of medulloblastoma patients. Besides endocrinological and other somatic sequelae of the disease and treatment, increased neuropsychiatric problems showed us that only cure is not the issue while treating childhood medulloblastoma.

Comparing the Efficiencies of Hyperbaric Oxygen Therapy and Intratympanic Steroid Treatment for Sudden Hearing Loss.

OBJECTIVES: To compare the efficiencies of hyperbaric oxygen therapy (HBOT) and intratympanic steroid (ITS)treatment for idiopathic sudden sensorineural hearingloss (ISSHL). MATERIALS AND METHODS: A total of 136 patients who were treated for ISSHL were reviewed fromthemedical records. All of the patients were given systemic steroid therapy (SST). Among them,33patients received HBOT and 36 patients received ITS treatment following SST. The starting time to treatment, risk factors, hearing level, hearing gain (HG), and recovery rate were evaluated from retrospectiverecords. RESULTS: No substantial change in HG was observed for either the HBOT or ITS treatment cohort (p>0.05). But the time to recovery was higher in the ITS treatment cohort (40%) than in theHBOT cohort (17%). The starting time to ITS treatment was 4 days (range: 1-30) and that to HBOT was 8 days (range:3-30). There was a significant difference in the starting time to treatment (Mann-Whitney U-test, p=0.043). Also, hearing loss in the HBOT group was significantly higher than in the ITS treatment group. A significant difference was observed before and after ITS treatment (p<0.05). CONCLUSION: In patients compared with late-onset treatment, ITS may be more effective than HBO after SST failure. It can be used as salvage therapy in patients with ISSHL who are unresponsive to a primary systemic steroid. We observed that HBOT didnot improve results when it was started late. Therefore, more studies that include both ITS treatment and HBOTas anearly treatment option are needed.

Effect of preoperative hearing level on success of stapes surgery.

OBJECTIVE: We evaluated functional results after stapedotomy in terms of the influence of preoperative hearing threshold. STUDY DESIGN: Case series and chart review. SUBJECTS AND METHODS: We classified 141 patients according to preoperative mean air-conduction threshold: 40 to 54 dB, group 1; 55 to 69 dB, group 2; and 70 to 89 dB, group 3. Speech discrimination scores also were noted. RESULTS: All groups showed significant improvement. The greatest increase in postoperative speech discrimination score was seen in group 3. Group 1 improved from moderate hearing loss (mean, 49 dB) to normal (mean, 24 dB); group 2, from moderately severe loss (mean, 61.2 dB) to mild (mean, 28 dB); and group 3, from severe loss (mean, 76.4 dB) to moderate (mean, 41.1 dB). CONCLUSION: Success in treating otosclerosis does not depend on extent of preoperative hearing loss. Patients with severe loss improved to moderate, increasing the benefit from use of a hearing aid. The patients attained good auditory function, improving their quality of life.

Correlation of diagnostic systems with adenoidal tissue volume: a blind prospective study.

OBJECTIVES: To determine the correlation between adenoid tissue volume and three diagnostic methods of deciding whether to perform an adenoidectomy. METHODS: The study used 152 patients (mean age, 5.8+/-2.5 years; age range, 2-12 years) who underwent an adenoidectomy at our clinic between April 2005 and April 2007. Patients requiring a revision operation and those with a cleft palate were excluded. To estimate the extent to which the adenoid narrowed the choana, an evaluation was made using nasal endoscopy (%), a mirror (%), and palpation (rated from 1 to 5) with the patient in Rose's position just before surgery. Postadenoidectomy tissue volume was measured (in cm(3)). The Spearman rank correlation and stepwise linear regression analyses were used to statistically evaluate the data. RESULTS: Nasal endoscopy revealed that the choana was narrowed by the adenoid at an average of 86.6+/-13.1% (range, 50-99%). When viewing upward by a mirror, the choana was observed as being narrowed at an average of 44.2+/-30.2% (range, 5-100%). The mean palpation value was 3.2+/-1.4 (range, 1-5). The mean volume of adenoidal tissue measured was 1.8+/-0.8 cm(3) (range, 0.7-4.5 cm(3)). Nasal endoscopy was determined to be the best means of checking by the Spearman rank correlation. Mirror (R=0.64, P<.0001), palpation (R=0.62, P<.0001), and volume (R=0.62, P<.0001) were correlated with the nasal endoscopy; however, regression analysis found that only palpation (P=.003) and volume (P<.001) were independent variables affecting the image of nasal endoscopy, mirror inspection (P=.260) was not. CONCLUSIONS: Nasal endoscopy is considered the most important tool to indicate adenoidectomy. This study showed that nasal endoscopy and palpation provide the most accurate determination of the volume of adenoidal tissues dissected by adenoidectomy.

Unilateral inferior turbinate agenesis: a case report.

Many common anatomic variations in the nasal cavity have been observed, including paradoxical turbinates and pneumatization of the inferior, middle, and superior turbinates. We describe a case of a rare anomaly-unilateral inferior turbinate agenesis-in a 65-year-old man who had presented with epistaxis. During evaluation, anterior rhinoscopic examination revealed the absence of the right inferior turbinate; this finding was confirmed on computed tomography. The patient had never undergone nasal or sinus surgery, and he denied ever having expelled anything of significance from his nasal cavity. This case merits attention because of the rarity of reports on turbinate agenesis.

[Utility of fine-needle aspiration biopsy in head and neck masses]. / Bas-boyun kitlelerinde ince igne aspirasyon biyopsisinin yeri.

OBJECTIVES: We investigated the utility of fine-needle aspiration biopsy (FNAB) for head and neck masses, and compared FNAB results with histopathologic diagnoses. PATIENTS AND METHODS: In a group of 352 patients (168 males, 184 females; mean age 44+/-19 years; range 2 to 94 years) who were operated on for head and neck masses, FNAB was performed in 167 patients (47.4%). The results of FNAB were compared with histopathologic diagnoses in four groups of localization: parotid, thyroid, submandibular gland, and cervical levels. Sensitivity, specificity, positive predictive and negative predictive rates of FNAB were calculated for each group. RESULTS: There were 64 parotid (38.3%), 29 thyroid (17.4%), 19 level V (11.4%), 18 level II (10.8%), 14 level III (8.4%), 9 level I (5.4%), and 7 submandibular gland (4.2%) masses. The overall correlation of FNAB with histopathologic diagnoses was 71.9%, being 76.6% in parotid, 75.9% in thyroid, 57.1% in submandibular gland, and 67.2% in neck (levels I-VI) masses. The highest sensitivity, specificity, positive predictive and negative predictive rates were determined for parotid masses (98%, 93.3%, 98%, 93.3%, respectively), whereas the lowest rates were obtained in submandibular gland masses (50%, 66.7%, 66.7%, 50%, respectively). CONCLUSION: The use of FNAB for head and neck masses, in particular parotid masses, provides considerable contribution to treatment planning.

Complications of Formaldehyde Injection for a Cystic Mass of the Neck.

Formaldehyde is a colorless reactive chemical with suffocating and pungent odor. It is irritant to mucous membranes and can enter the body by either oral ingestion or inhalation. Formaldehyde is toxic to living tissue. In this report, we present the case of a 22-year-old woman who was treated with formaldehyde injection for a cystic mass of the neck with developing complications.