Survivin expression correlates with nodal metastasis in T1-T2 squamous cell carcinoma of the tongue.

In this study, the correlation between neck metastasis and recurrence was investigated by studying specimens of tongue squamous cell carcinoma patients immunohistochemical with survivin antibodies in the primary biopsy. A retrospective review was conducted at the Academic University Hospital. 46 patients who had squamous cell carcinoma of the tongue, who underwent various types of glossectomy and neck dissections between 1991 and 2008, were evaluated. The patient's sex, TNM staging, differentiation and recurrence rates were analyzed. There were 20 T1 patients and 26 T2 patients; 27 of the patients were N0 and 19 had metastatic lymph nodes in the neck. Survivin antibodies were applied with streptavidin-biotin method to the sections that were prepared from the primary tumor biopsy specimens of the patients. The correlation between neck metastasis and recurrence and survivins' immunohistochemical staining was analyzed with statistical methods. There were no significant differences between the patient's age, sex, tumor's T stage, tumor differentiation and survivin staining density. Survivin staining was positive in 15 (79 %) of 19 patients with neck metastasis, while it was positive in 16 (59 %) of 27 patients without neck metastasis. Eleven (79 %) of the 14 patients who had recurrence and all 6 patients who had neck recurrence only were stained by survivin. Expression of nuclear and cytoplasmic survivin can be a useful marker for predicting cervical lymph node metastasis in T1-T2 tumors in tongue SCC.

Protective effect of thymoquinone against cisplatin-induced ototoxicity.

The aim of this study was to investigate the potential protective effect of thymoquinone against cisplatin-induced ototoxicity. This study is a prospective, controlled experimental animal study. Experiments were performed on 30 healthy female Sprague-Dawley rats. Thirty animals were divided into three groups of 10 animals each. Group 1 received an intraperitoneal (i.p.) injection of cisplatin 15 mg/kg. Group 2 received i.p. thymoquinone 40 mg/kg/day for 2 days prior to cisplatin injection and third day i.p. cisplatin 15 mg/kg was administered concomitantly. Group 2 continued to receive i.p. thymoquinone until fifth day. Group 3 received i.p. thymoquinone 40 mg/kg/day for 5 days. Pretreatment distortion product otoacoustic emissions (DPOAE) and auditory brain stem responses (ABR) testing from both ears were obtained from the animals in all groups. After the baseline measurements, drugs were injected intraperitonally. After an observation period of 3 days, DPOAE measurements and ABR testing were obtained again and compared with the pretreatment values. There was no statistically significant difference between pre and post-treatment DPOAE responses and ABR thresholds group 2 and 3. However, group 1 demonstrated significant deterioration of the ABR thresholds and DPOAE responses. Our results suggest that DPOAE responses and ABR thresholds were preserved in the cisplatin plus TQ-treated group when compared with the group receiving cisplatin alone. According to these results, cisplatin-induced ototoxicity may be prevented by thymoquinone use in rats.

Efficacy of a single preoperative dose of pregabalin for postoperative pain after septoplasty.

We aimed to investigate the role of preoperative single dose of pregabalin for attenuating postoperative pain and analgesic consumption in patients undergoing septoplasty. One hundred forty-three patients with ASA physical status I who underwent elective septoplasty were included in this prospective, randomized, and controlled study. Subjects were randomized to receive pregabalin 75 mg, pregabalin 150 mg, and control group. All the medications were administered orally 1 hour before surgery. A standard septoplasty technique was used for all patients. Postoperative pain intensity was evaluated by a 0- to 100-mm horizontal visual analog scale (VAS) (0, no pain; 100, worst imaginable pain). Total analgesic consumption 1 to 24 h after operation was also recorded.Visual analog scale scores in the 1st, 2nd, 4th, 6th, 12th, and 24th hour were significantly decreased in 75 and 150 mg pregabalin group compared with the control group, and VAS scores in the 12th and 24th hour were significantly decreased in pregabalin 150 mg compared with 75 mg. The 24th total analgesic consumption was significantly decreased in pregabalin 75 mg and 150 mg groups compared with the control group.In conclusion, a single preoperative oral dose pregabalin 75 or 150 mg is an effective method for reducing postoperative pain and total analgesic consumption in patients undergoing septoplasty.

Evaluation of treatment efficacy in patients with minimal nasal septum deviation and concha bullosa using the nasal obstruction symptom evaluation scale.

OBJECTIVES: This study aims to compare the treatment efficacy of middle turbinate lateral lamella resection alone with septoplasty plus middle turbinate lateral lamella resection for nasal stuffiness in two patient groups using the nasal obstruction symptom evaluation (NOSE) scale in patients with concomitant minimal nasal septum deviation and concha bullosa. PATIENTS AND METHODS: A total of 80 patients who had minimal nasal septum deviation and concha bullosa at the middle turbinate were included in this study. Of these patients, 40 patients underwent middle turbinate lateral lamella resection, while 40 patients underwent middle turbinate lateral lamella resection plus septoplasty under general anesthesia. Complaints of nasal stuffiness in patients included were evaluated with the NOSE scale before the operation and three months after the operation. RESULTS: When preoperative and postoperative NOSE scale parameters were compared, all parameters statistically significantly improved postoperatively in both groups (p<0.05). The total NOSE scores were decreased significantly after surgery. CONCLUSION: Middle turbinate lateral lamella resection alone is as efficient as septoplasty plus middle turbinate lateral lamella resection for the treatment of symptomatic nasal stuffiness in selected patients.

Impact of septoplasty on mean platelet volume levels in patients with marked nasal septal deviation.

Nasal septal deviation (NSD) is a very common cause of recurrent and chronic nasal obstruction. Chronic nasal obstruction leads to increased upper respiratory tract resistance, and also upper respiratory tract resistance leads to chronic hypoxia and hypercarbic because of alveolar hypoventilation. Chronic hypoxia and hypercarbia show tendency for hypercoagulopathy.Mean platelet volume (MPV), the most commonly used measure of platelet size, is a potential marker of platelet reactivity. Large platelets that contain more dense granules are enzymatically and metabolically more active and have greater prothrombotic potential. In previous studies, increased MPV was demonstrated in hypertension, unstable angina pectoris, myocardial infarction, stroke, and obstructive sleep apnea.We aimed to determine whether MPV levels are elevated in patients with marked NSD (MNSD) compared with healthy controls. In addition, we tried to find out the effect of nasal septoplasty on MPV levels. We found that the MPV levels were significantly higher in the MNSD group than in the control healthy group, and also we found that MPV levels were significantly decreased in the MNSD group after septoplasty operation.In conclusion, in our knowledge, this is the first study investigating MPV levels in patients with MNSD. Increased platelet activation may be related to increase the cardiovascular risk in patients with MNSD. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with MNSD, and the increase in MPV levels of the cases with MNSD could be treated by septoplasty.

An unusual mass filling within the middle meatus.

Schwannoma is a benign tumor that originates from sheath of myelinated peripheral nerves, rarely seen at the nasal cavity and paranasal sinuses. Symptoms of this tumor are nonspecific, and diagnosis is often made only after histological examination. Schwannoma is radioresistant, and chemotherapy is not effective, so surgical resection is the only curative treatment for this tumor. Endoscopic sinus surgery was the first choice for this case because of its definite origin and being easy to remove for complete excision. We present a patient with schwannoma who underwent an endonasal endoscopic approach for complete resection.

Protective effect of N-acetylcysteine from drug-induced ototoxicity in uraemic patients with CAPD peritonitis.

AIM: Peritonitis is currently one of the leading complications of continuous ambulatory peritoneal dialysis (CAPD) treatment. Aminoglycosides and vancomycin are used in the treatment of CAPD peritonitis despite their potential risk for ototoxicity. N-acetylcysteine (NAC) is a molecule used in the treatment and prophylaxis of many diseases related to oxidative stress. The aim of this study was to examine whether ototoxicity due to antibiotics used in the treatment of CAPD peritonitis can be prevented by NAC. METHODS: Sixty patients, who first developed CAPD peritonitis attacks from February 2008 to April 2010 were included in this study. Patients were divided into two groups, those taking an additional NAC treatment (n = 30) and a control group (n = 30). Low- and high-frequency hearing function tests were performed on the two groups before treatment (baseline), at the end of the first (early follow-up) and the fourth week after the treatment (late follow-up). Total doses of vancomycin and amikacin were recorded. RESULTS: There was no statistically significant difference between the groups in terms of hearing functions at the beginning. However, patients taking NAC had better hearing function test results 4 weeks after the treatment compared with those of the control group (P < 0.05). There were no statistical differences between posttreatment low-frequency hearing function tests conducted at the baseline and the first and the fourth weeks in patients taking NAC. The first and the fourth week's low-frequency hearing functions worsened when compared with the baseline low-frequency results in the control group (P < 0.001). It was found that NAC had a protective effect against ototoxicity on low-frequency (0.25-8 KHz) hearing functions. The first and the fourth week's high-frequency hearing functions improved when compared with baseline high-frequency hearing functions in patients taking NAC (P < 0.05), while they worsened. The first and fourth week's high-frequency tests worsened when compared with the baseline high-frequency tests in the control group (P < 0.001). CONCLUSIONS: The present study suggests that intraperitoneal aminoglycoside and vancomycin administration in CAPD patients may cause low- and high-frequency hearing loss, and this ototoxic effect is related to the dose given. It was found that when the antioxidant NAC is administered alone, it prevents ototoxicity, associated with intraperitoneal amikacin and vancomycin in patients with CAPD peritonitis. In addition, it was revealed that NAC may also have a curative effect on impaired high-frequency hearing functions.

Large radicular cyst in the maxillary sinus.

Radicular cysts (RCs) are the most common inflammatory jaw cystic lesions that occur infected and necrotic in teeth pulps. They account for more than 50% of all odontogenic cysts. Radicular cysts cause slowly progressive painless swelling. There are no symptoms until they become large. Enucleating the cyst is recommended with primary treatment. Here we describe a patient with a large RC with maxillary sinus involvement who underwent an endonasal endoscopic approach for complete resection. In conclusion, the endonasal endoscopic approach should be kept in mind for the resection of RC with maxillary sinus involvement because of its minimally invasive characteristics.

Correlation between hearing loss and peritonitis frequency and administration of ototoxic intraperitoneal antibiotics in patients with CAPD.

AIM: Aminoglycosides have been used in the treatment of CAPD peritonitis despite their potential risk for ototoxicity. The ototoxicity risk of intraperitoneally administered aminoglycosides has been investigated by a number of studies. However, their results are somewhat conflicting. The aim of the present study was to examine the frequency of hearing loss and the correlation between the repeated doses of aminoglycosides and hearing loss in CAPD peritonitis therapy. METHODS: Hearing functions of the CAPD patients who had developed peritonitis and had been treated with various antibiotics including aminoglycosides were compared with those CAPD patients who had never developed peritonitis. Threshold values for hearing were determined through "pure tone audiometry" measurements. RESULTS: Hearing threshold levels of the patients with history of peritonitis were found to be significantly higher in both lower [pure tone averages - 1 (PTA-1)] and higher [pure tone averages - 2 (PTA-2)] frequencies, when compared to the ones with no history of peritonitis (p values were 0.001 and 0.007, respectively). CONCLUSION: The present study showed that intraperitoneal aminoglycoside administration in CAPD patients is associated with the development of hearing loss. The severity of hearing loss may range from mild hearing loss to profound deafness. A remarkable correlation exists between the severity of the hearing loss and the repeated and total aminoglycoside dose received.

Protective effect of N-acetylcysteine against cisplatin ototoxicity in rats: a study with hearing tests and scanning electron microscopy.

INTRODUCTION: Ototoxicity is a health problem appearing after powerful treatments in serious health conditions. It is sometimes inevitable when treatment of the serious disease is required. Cisplatin is an antineoplastic agent which was investigated previously to reveal increased nitrogen and reactive oxygen radicals that damages hair cells, resulting in ototoxicity. N-acetylcysteine, previously shown to decrease ototoxicity caused by different agents, is known to be a powerful in vitro antioxidant. Probably N-acetylcysteine, in addition to its antioxidant effect, blocks a cascade where reactive oxygen species result in apoptosis in the cochlea. OBJECTIVES: The possible preventive effect of N-acetylcysteine in cisplatin ototoxicity was studied with auditory brain stem responses, otoacoustic emissions, and histopathological investigation of the cochlea in a scanning electron microscopy. METHODS: This study was conducted on 21 Wistar Albino rats in four groups. 1mL/kg/day three times in total intraperitoneal (i.p.) Saline (n=5), 500mg/kg/day i.p. three times in total N-acetylcysteine (n=5), i.p. 15mg/kg cisplatin alone (single dose) (n=5) and i.p. 15mg/kg cisplatin plus 500mg/kg/day N-acetylcysteine (n=6) were administered. The rats were anesthetized to study the hearing tests before and after the experiment. The rats were sacrificed to investigate the cochleas by scanning electron microscopy. RESULTS: Auditory brain stem responses and otoacoustic emissions values were attenuated in the cisplatin group. The group that received N-acetylcysteine in addition to cisplatin had better auditory brain stem responses thresholds and otoacoustic emissions. The samples obtained from the cisplatin group showed surface irregularities, degeneration areas, and total or partial severe stereocilia losses. The changes were milder in the cisplatin+N-acetylcysteine group. CONCLUSION: Cisplatin ototoxicity can be detected by auditory brain stem responses and otoacoustic emissions testing in rats. N-acetylcysteine may protect the cochlear cells from histopathological changes. We concluded that N-acetylcysteine given 4h after cisplatin injection has a potential otoprotective effect against cisplatin ototoxicity. which suggests it could be used in clinical trials.

Figure-of-eight vertical mattress suture technique for anterior flap suspension to overlying tissues in external dacryocystorhinostomy.

PURPOSE: To describe figure-of-eight vertical mattress suture technique in external dacryocystorhinostomy for a combined one-step closure of anterior mucosal flaps and overlying wound tissues and to evaluate its effectiveness on surgical outcome. DESIGN: A prospective, single surgeon, uncontrolled, interventional case series. METHODS: A total of 112 consecutive lacrimal drainage systems of 106 patients (84 women, 22 men; 100 unilateral, six bilateral) from June 2002 to January 2006 with acquired nasolacrimal duct obstruction without canalicular disease underwent external dacryocystorhinostomy with this modified technique. Relief of epiphora and anatomic patency were defined as success. Operative time and success rate were evaluated and advantages were stressed and compared with our previous reports. RESULTS: Mean age was 40.1 years (range, 6 to 75). The etiology was idiopathic in 109 patients and traumatic in three cases. Of 112 lacrimal drainage systems, epiphora was the presenting symptom in 88, combined epiphora and recurrent dacryocystitis in 15, and combined epiphora and mucocele in nine cases. Seven lacrimal drainage systems were revision cases. Mean follow-up was 26.3 months (range, 6 to 48). Success rate was 99.1% (111/112) and mean operative time was 38.2 minutes (range, 28 to 69). CONCLUSIONS: Such a modified suture technique reveals a rapid and simultaneous one-step closure of two different layers that speeds up surgical procedure; simplifies closure process as the knots are tied completely outside the wound, avoiding the disadvantages of suture tying in a small and deep area; eliminates the dead space between anterior flaps and overlying wound tissues; keeps anterior mucosal flap complex away from posterior flaps that prevents collapse back onto the anastomosis and decreases the possibility of mucosal adhesions and, therefore, fibrotic band formation with underlying tissues that may also be useful in cases with small sacs or osseous openings and in revision cases where scarring is a large concern.

Quantitative evaluation of new bone and fibrous tissue in the cochlea following cochlear implantation in the human.

The formation of new bone and fibrous tissue in the human inner ear following cochlear implantation was evaluated by computer-assisted 3-D reconstruction. Seven temporal bones from patients who in life had undergone cochlear implantation were prepared for histological study with the implant in situ. The specimens were sectioned in the axial plane at a thickness of 20 microm. At least every tenth section was digitally reconstructed in three dimensions and volumes of new bone and fibrous tissue were calculated per millimeter length of the cochlea. New bone and fibrous tissue were found in all seven specimens, particularly at the cochleostomy site. In addition, new bone and fibrous tissue had extended to variable lengths along the track of the cochlear implant and in some cases extended beyond the distal end of the implanted electrode. This methodology provides a quantitative tool for evaluation of new bone and fibrous tissue in the inner ear following implantation. This should assist in correlating psychophysical and speech perception tests with intracochlear pathology, evaluating both electrode design and the techniques of preserving residual auditory function.

Analysis of intracochlear new bone and fibrous tissue formation in human subjects with cochlear implants.

OBJECTIVES: In this study we aimed to evaluate new bone and new fibrous tissue formation in the inner ear following cochlear implantation. METHODS: Twelve temporal bones from patients who underwent cochlear implantation during life were prepared for histologic study. The specimens were reconstructed by both 2-dimensional and 3-dimensional methods. These reconstructions were used to calculate the total volume and distribution of new bone and new fibrous tissue in the cochlea, the number of spiral ganglion cells, and other histopathologic parameters. Clinical data, including the last-recorded word recognition scores, were obtained from the patients' medical records. RESULTS: New bone and new fibrous tissue were found in all 12 specimens, particularly at the site of cochleostomy. There was a significant correlation between overall damage to the lateral cochlear wall and the total volume of intracochlear new tissue (Spearman rho = .853; p = .0004). The total volume of new tissue did not correlate with word recognition scores or spiral ganglion cell counts. CONCLUSIONS: These preliminary results suggest that the degree of damage to the lateral cochlear wall may play an important role in influencing the amount of new tissue formation following cochlear implantation. Intracochlear new tissue does not appear to be an important determinant of performance as measured by word recognition scores or the total number of remaining spiral ganglion cells.

[Adenoidal vegetations in adults: an evaluation of 12 cases]. / Eriskinlerde görülen adenoid vejetasyonlar: 12 olgunun degerlendirilmesi.

OBJECTIVES: We evaluated the clinical significance of adenoidal vegetations which are overlooked as a cause of nasal obstruction in adults. PATIENTS AND METHODS: The study included 12 patients older than 15 years of age (10 males, 2 females; mean age 23.5 years; range 15 to 32 years) who presented with nasal obstruction due to adenoidal vegetations. The patients were evaluated with respect to age, sex, complaints, findings of physical examination, computed tomography of the nasopharynx, and nasal endoscopy, and histopathologic results. RESULTS: All the patients had nasal obstruction. The most common symptom was snoring. Physical examination showed a vegetative mass in the posterior wall of the nasopharynx obstructing the choana. Five patients had bilateral serous otitis media and eight patients had postnasal purulent drainage. All the patients underwent adenoidectomy under general anesthesia and with transnasal endoscopic control. Histopathologic examination of surgical specimens showed lymphoid hyperplasia. CONCLUSION: Although adenoidal tissue undergoes regression toward the adolescent period, it may present as the chief cause of nasal obstruction in adults.

Research of genetic bases of hereditary non-syndromic hearing loss.

AIM: Hearing loss is the most common sensory disorder that affects approximately one per 1000 live births. With this project, we aimed to identify gene variants that were common causes of hearing loss in Turkey to contribute to the planning of genetic screening programs for hearing loss, as well as to improve genetic counseling to affected families. MATERIAL AND METHODS: Twenty-one families with at least two affected individuals and parental consanguinity who presented with non-syndromic severe-to-profound sensorineural hearing loss were included in this study. We first screened for mutations in GJB2 and mitochondrial DNA 12S RNA genes. Subsequently, we genotyped the TMIE c.250C>T and SNP markers flanking the SLC26A4, MYO7A, MYO15A, OTOF, CDH23, TMIE, TECTA, PCDH15, TMC1, TMPRSS3, TMHS genes in the remaining twelve families without mutations in GJB2. RESULTS: Screening for mutations in GJB2 gene showed c.[35delG];[35delG] mutation in four families, c.[35delG];[507C>A] mutation in two families, c.[35delG];[-23+1G>A] mutation in one family, and c.457G>A heterozygous mutation in one family. Genotyping SNP markers showed the c.[250C>T];[250C>T] mutation in TMIE in one family. A homozygous region with SNP genotypes was detected with the OTOF gene in one family, the TMPRSS3 gene in another family, and also a homozygous region was detected with TMHS, OTOF, and TMPRSS3 genes in another family. CONCLUSIONS: Further research will be required to determine the genetic bases of hearing loss in families with non-syndromic hearing loss.

Auditory brainstem implant in postlingual postmeningitic patients.

OBJECTIVES/HYPOTHESIS: The aim of this study was to evaluate outcomes of postlingual postmeningitic patients who received an auditory brainstem implant (ABI). STUDY DESIGN: Retrospective analysis was performed on postlingual postmeningitic patients with bilateral profound sensorineural hearing loss who underwent ABI between the years 2007 and 2014 METHODS: All patients were postlingually deaf due to cochlear ossification as a consequence of bacterial meningitis. The patients received a MED-EL or Neurelec ABI. All patients were operated on at different hospitals by the same primary surgeon. The patients were tested using Ling 5 sound detection, sound field implant thresholds between 250 Hz and 6 kHz, and 6 to 12 choice closed-set word and sentence tests. RESULTS: Nine patients with postmeningitic cochlear ossification received an ABI. Five of nine ABI users (55.5%) wear their audio processors (AP) most of the time. Four (44.5%) with no perceivable benefit have become nonusers. Three of the five consistent ABI users reported good benefit. The other two ABI users who do wear their APs do not respond to sound in daily living but reported benefits such as "feeling sound" in a good way. CONCLUSIONS: In this study, five of nine patients (55.5%) with bilateral ossified cochlea had some degree of benefit from their ABI. An ABI may be useful in hearing restoration in postlingual patients with bilateral ossified cochlea due to meningitis. However, poor results may be related to side effects, which may necessitate deactivation of electrodes, long duration of auditory deprivation, or impairments in the auditory neural structures as a result of meningitis. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1889-1892, 2016.

N-acetylcysteine Prevents Gentamicin Ototoxicity in a Rat Model.

OBJECTIVE: The possible preventive effect of N-acetylcysteine (NAC) in gentamicin ototoxicity was studied with auditory brain stem responses (ABRs), otoacoustic emissions (OAEs), and histopathological investigation of the cochlea. MATERIALS AND METHODS: This study is conducted on 36 rats in three groups. Gentamicin, gentamicin plus NAC, and NAC alone were intraperitoneally administered for 15 days. The rats were sacrificed to study the cochleas after testing hearing levels. RESULTS: ABR thresholds and OAEs were attenuated in the gentamicin group, in which apoptosis was detected with histopathological investigation. The group that received NAC in addition to gentamicin had better ABR thresholds and better OAEs. The histopathological evidence of apoptosis in was considerably less in this group. CONCLUSION: Gentamicin ototoxicity can be detected by ABR and OAE testing in rats, and NAC may protect the cochlear cells from apoptosis.

Castleman's disease as an unusual neck mass: case report.

Castleman's disease is a rare, benign disease of unknown cause that induces reactive lymph node hyperplasia, most commonly in the mediastinum. It has 2 histologic subtypes: hyaline vascular and plasma cellular. A definitive diagnosis necessitates tissue biopsy. A specimen may be even misdiagnosed as lymphoma in frozen section. Surgery is the treatment of choice for the solitary form, whereas chemotherapy, radiotherapy, and steroids are proposed for the multicentric type. A neck mass diagnosed as Castleman's disease in a 48-year-old woman is reported.

Tc-99m HMPAO brain SPECT in linear nevus sebaceous syndrome.

The authors present a case of linear nevus sebaceous syndrome (LNSS) with atrophy of bilateral frontotemporal areas of the brain, left cerebellum and hippocampus, and bilateral uncal dysplasia demonstrated by magnetic resonance imaging (MRI). Magnetic resonance angiography revealed bilateral internal carotid artery hypoplasia with absence of flow in the anterior and middle cerebral arteries. Tc-99m HMPAO brain SPECT demonstrated more areas of perfusion defects while MRI detected volume loss and gliosis in affected areas. Tc-99m HMPAO brain SPECT may be more useful for revealing absent or decreased perfusion areas of brain lesions than MRI in LNSS.

Efficacy of bupivacaine for post-tonsillectomy pain: a study with the intra-individual design.

OBJECTIVE: To determine the effectiveness of postoperative local anesthesia in tonsillectomy patients using an intra-individual study design. METHODS: Thirty patients aged 5-15 were included in a prospective study. Patients received a local infiltration of 0.5% bupivacaine solution on the right tonsillar bed, and received a local infiltration of normal saline on the left tonsillar bed. Patients were asked to localize pain in terms of most disturbing side of the pharynx, on the 1st, 4th, 8th, 16th, 24th hours. RESULTS: Regarding pain over a 24-h period, there was a significant difference between two sides, after the 8th hour. CONCLUSION: Postoperative local bupivacaine infiltration in tonsillectomy patients was effective in children.