Is Salvage Hyperbaric Oxygen Therapy Effective for Sudden Sensorineural Hearing Loss in Patients with Non-response to Corticostreoid Treatment?

PURPOSE: The aim of this study was to evaluate the efficacy of salvage hyperbaric oxygen therapy (HBOT) for sudden sensorineural hearing loss (SSNHL); HBOT is performed after three weeks of the onset of the disease. METHODS: This retrospective clinical study included patients with unilateral idiopathic SSNHL. All patients admitted to the hospital with the diagnosis of SSNHL were given standard steroid treatment within the 14 days of the onset of the SSNHL. We compared the two study groups - Group A: patients receiving steroid treatment within the first 14 days; Group B: patients receiving corticosteroid treatment within the first 14 days, but unresponsive to this treatment, and began to receive HBOT after three weeks of the onset of SSNHL for the purpose of salvage therapy. RESULTS: A total of 50 patients were included in the study. The mean age of the patients was 50.6 ± 14.1 years. There was not a significant difference in the degree of hearing loss between the groups based on the findings from audiometric examinations performed at the time of diagnosis. It was observed that salvage HBOT was not effective when the initial and post-treatment audiometric tests were compared. CONCLUSION: According to our results, salvage HBOT was not efficient when performed three weeks after the onset of the SSNHL for patients who did not respond to corticosteroid treatment.

[Surgical management of lower lip cancers]. / Alt dudak kanserlerine cerrahi yaklasim.

OBJECTIVES: We evaluated the results of surgical treatment of lower lip cancers. PATIENTS AND METHODS: The study included 47 patients (7 females, 40 males; mean age 53 years; range 34 to 71 years) who underwent surgery for primary lower lip carcinoma. Five patients received postoperative adjuvant radiotherapy. Data were reviewed on clinical features, risk factors, localization of the lesion, regional lymph node status, tumor staging, results of surgical treatment and pathological examination, locoregional recurrence, and prognosis. The mean follow-up period was 60.1 months (range 6 to 110 months). RESULTS: Histopathologic diagnosis was squamous cell carcinoma in all cases. Tumor differentiation was good in 39 patients (83%), moderate in seven patients (15%), and poor in one patient (2%). Stage 1 tumor was seen in 29 patients (61%). T and N staging were as follows: 31 T1, 14 T2, 2 T3; 40 N0, 6 N1, and 1 N2. Histopathologically, three N0 patients (7%), four N1 patients (66%) had lymph node metastasis, and one N2 patient had extracapsular invasion. Three patients (6%) had perineural invasion. Local recurrence developed in one stage 1 patient (9%) and in one stage 2 patient (16%). Neck recurrence was seen in three patients (6%). One stage 4 patient developed distant metastasis two years after the diagnosis. Mortality occurred due to lip cancer in five patients (10%), and to other causes in seven patients (15%). Of 35 patients who survived, 34 (72%) were disease-free. CONCLUSION: Due to its advantages, surgery should be the treatment of choice for cancers of the lower lip of any stage.

[Transpalatal approach in juvenile nasopharyngeal angiofibroma]. / Juvenil nazofarenks anjiyofibromunda transpalatal yaklasim.

OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) cases treated with transpalatal approach were evaluated with respect to localization, complications, intraoperative blood loss, recurrence, and prognosis. PATIENTS AND METHODS: The study included 15 male patients (mean age 13 years; range 10 to 16 years) treated for JNA. The patients were classified according to the Chandler staging system. Transpalatal surgical excision was performed in 14 patients. Preoperative embolization of the maxillary arteries was performed in three patients. One patient with intracranial extension was treated with radiotherapy. The mean follow-up was 3 years and 7 months (range 7 months to 7 years). RESULTS: Three patients (20%) had Chandler stage II, 11 patients (73%) had stage III, and one patient (7%) had stage IV disease. The mean intraoperative blood loss was 575 ml in three patients with preoperative embolization, and 1,079 ml in those without embolization. The average intraoperative transfusion requirement was 2.3 units. Recurrences developed in three patients (20%), two of whom were treated by surgery and one by radiotherapy. CONCLUSION: Transpalatal surgical approach is effective in the treatment of JNAs localized in the nasopharynx, nasal cavity, and sphenoid sinuses, with minimal mortality and morbidity.

Functional and aesthetic results obtained by modified Bernard reconstruction technique after tumour excision in lower lip cancers.

BACKGROUND: In this study, we investigated the functional and aesthetic results in new lip formation using modified Bernard reconstruction technique after tumour excision in lower lip cancers. MATERIAL AND METHODS: The study included 47 patients. All were operated due to lower labial squamous cell carcinoma and underwent defect reconstruction using modified Bernard technique. The patients were separated into two groups as: 50-70% and 70% total defect occurring after surgical excision. The functional and aesthetic assessments were done after at least 1 year had passed, and the results were compared statistically with a control group. RESULTS: Of the 18 patients with 50-70% defect, sensibility was normal in 16 (89%) and complete competence was determined in all (100%). In 17 patients (94%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in all patients. Nasolabial asymmetry was detected in one patient (6%) and apparent mentolabial scar tissue was detected in two patients (11%). The new vermilion was of equal width to the upper lip vermilion in 15 patients (83%). Of the 29 patients with 70% total defect, sensibility was normal in 21 (72%) and complete competence was detected in 27 patients (93%). Sialorrhoea on fluid intake was detected in one patient (3.5%) and sialorrhoea at rest in one patient (3.5%). In 22 patients (76%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in 27 (93%) of the 29 patients. Asymmetry in nasolabial fold was detected in one patient (3.5%), apparent scar tissue in nasolabial fold in one patient (3.5%) and commissure asymmetry in one patient (3.5%). In 25 patients (86%), the new vermilion was of equal width to the upper lip vermilion. No statistically significant difference was found (p>0.05) among the two patient groups and the control group in terms of functional and aesthetic results. CONCLUSION: Modified Bernard technique provides a good degree of lip mobility and sensation after excision of lower lip malignant tumour and produces acceptable results.

Development of a Hodgkin disease tumor in the neck of a patient who previously had undergone complete excision of a hyaline-vascular Castleman disease neck mass.

Castleman disease is an uncommon cause of a neck mass. A benign lymphoproliferative disorder, it may be seen as a self-limited unicentric process or as a fulminant multicentric disease with systemic symptoms. The association between Hodgkin disease and Castleman disease has been debated extensively, but this association is rare. The associated Hodgkin disease frequently has been of the interfollicular subtype and typically has coexisted with the multicentric plasma-cell variant of Castleman disease. We report a case of mixed-cellularity Hodgkin disease of the neck in a patient previously diagnosed with hyaline-vascular-type Castleman disease who had undergone complete excision of a neck mass 2 years earlier.

Evaluation of nasal symptoms and mucociliary function in patients with allergic rhinitis treated with chemosurgery using trichloroacetic acid.

PURPOSE: We treated allergic rhinitis with trichloroacetic acid (TCA) applied to the inferior turbinates. Further clinical evaluations were made to determine the effect of TCA application on symptoms of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance. MATERIALS AND METHODS: A group of 54 patients with perennial allergic rhinitis was treated with 80% TCA applied to the inferior turbinate. Further clinical evaluations were made to determine the effect of TCA application on symptom scores of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance in those cases. RESULTS: The most common complaint, nasal obstruction, improved effectively in 82% of cases, watery rhinorrhea in 86%, and sneezing in 86%, 1 year after treatment. A significant decrease in scoring was noted for subjective nasal obstruction, watery rhinorrhea, and sneezing. Nasal airway resistance was effectively reduced 1 year after treatment, and the difference was statically significant. In our study, saccharin time appeared to be shortened in the early and late periods after the TCA application. There was a statistical difference between the before- and after-treatment groups. CONCLUSIONS: We concluded that TCA treatment was quite effective for controlling nasal allergic symptoms and that it does not damage the mucociliary function.