Primary nasopharyngeal tuberculosis.

Primary nasopharyneal tuberculosis is a rare disease which is commonly present with cervical lymphadenopathy. It is hard to differenciate the diagnosis of tuberculosis from nasopharyngeal carcinoma. Histologic and bacteriologic evaluation is required for diagnosis. A male patient at the age of nineteen applied to our clinic with the complaints of a mass in the neck, congestion in the nose, night sweating and weight loss. Clinical presentation of the patient was similar to that of a malignant tumor of the nasopharynx. Histologic and bacteriologic study supported the diagnosis of tuberculosis. After anti-tuberculosis therapy, the complaints of the patient regressed. We present a nasopharyngeal tuberculosis case in this study.

[Analysis of the psychological symptoms of patients following surgery for laryngeal cancer]. / Larenks kanseri nedeniyle ameliyat olan hastalarin psikolojik semptom dagiliminin incelenmesi.

OBJECTIVES: We evaluated psychological symptoms of patients who underwent partial or total laryngectomy for larynx cancer. PATIENTS AND METHODS: The study included 63 patients who underwent total (n=41) or partial (n=22) laryngectomy. The control group consisted of 20 healthy individuals with similar gender, age, and sociocultural characteristics. During the postoperative follow-up, the psychological symptom distribution of the patients was assessed with the Symptom Check-List-90-Revised (SCL-90-R). RESULTS: The SCL-90-R inventory was administered at a mean of 20.6 months (range 10 to 86 months) postoperatively. Patients with total laryngectomy had significantly higher scores than the controls in the subscales of interpersonal sensitivity, depression, anger-hostility, phobic anxiety, and global symptom index (p<0.05). Partial laryngectomy patients exhibited lower scores than total laryngectomy patients, and higher scores than the control group. The only significant difference between partial laryngectomy patients and the control group was in the subscale of anger-hostility (p<0.05). CONCLUSION: Patients with laryngeal cancer should be given postoperative psychological support to minimize adverse effects of total or partial laryngectomy.

Influence of anaesthetic agents on transient evoked otoacoustic emissions and stapedius reflex thresholds.

This aim of this study was to determine the effect of anaesthetic agents on stapedius reflex (SR) thresholds and transient evoked otoacoustic emissions (TEOAE). Fifty patients who were scheduled for operation and who had normal hearing were included in the study. All were given midazolam for premedication and propofol for induction. Anaesthesia was maintained in five different ways in each group of 10 patients. Groups I-IV received inhalational anaesthesia: group I received 70 per cent N2O plus 30 per cent O2, group II sevoflurane, group III desflurane and group IV halothane. Group V received total intravenous anaesthesia with propofol plus sufentanil. The SR and TEOAE of the patients were measured four times: on the day before surgery (first measurement), after premedication (second measurement), after induction of anaesthesia (third measurement) and during maintenance of anaesthesia (fourth measurement). Midazolam significantly increased ipsilateral and contralateral SR thresholds and decreased TEOAE wave reproducibility. Propofol significantly increased only the SR thresholds. The other anaesthetic agents significantly increased only the contralateral reflex thresholds. Of these, the highest increase was seen after sevoflurane and the lowest after halothane. The changes in TEOAE wave reproducibility due to anaesthetic agents used for maintenance were not significant. We concluded that midazolam premedication may affect audiological evaluation with SR and TEOAE tests, and sevoflurane should not be used when it is necessary to measure SR under general anaesthesia.

[Assessment of patients with sudden hearing loss by transcranial Doppler ultrasonography]. / Ani isitme kayipli hastalarin transkraniyal Doppler ultrasonografi ile degerlendirilmesi.

OBJECTIVES: We evaluated the utility of transcranial Doppler ultrasonography in determining the vascular pathology in patients with sudden hearing loss. PATIENTS AND METHODS: The study included 13 patients (11 males, 2 females; mean age 46.6+/-17.7 years; range 18 to 66 years) with a diagnosis of sudden hearing loss. Patients having chronic otitis media or other middle ear diseases or a history of surgery in the affected ear were excluded. All the patients were evaluated by pure-tone audiometry, impedance audiometry, transient evoked otoacoustic emissions, auditory brainstem responses, and transcranial Doppler ultrasonography. The results were compared with those of a control group of 19 age- and sex-matched healthy subjects (12 males, 7 females; mean age 46.8+/-6.9 years; range 33 to 58 years) who did not have any ear disease or a history of ototoxic drug intake or working in a noisy environment, and no pathology on otoscopic and audiometric examinations. RESULTS: Compared to the normal ear, the mean blood flow and systolic flow velocities of the vertebral artery were significantly decreased, and the mean pulsatile index was significantly increased on the affected side. The mean flow velocity of the basilar artery in the patient group was lower than that found in the control group. CONCLUSION: Transcranial Doppler ultrasonography can be used for the evaluation of vascular involvement of the vertebral and basilar arteries in patients with sudden sensorineural hearing loss.

Use of mometasone furoate aqueous nasal spray in the treatment of rhinitis medicamentosa: an experimental study.

OBJECTIVE: We aimed to investigate, histopathologic changes in the nasal mucosa of guinea pig's after prolonged administration of oxymetazoline and the development of rhinitis medicamentosa, and the efficacy of mometasone furoate aqueous nasal spray and saline in reversing the ultrastructural changes attributable to rhinitis medicamentosa. METHODS: In the study, 24 male guinea pigs (500 to 600 gr) were used. Oxymetazolin (0.05%) was sprayed into the nasal cavities of the guinea pigs 3 times daily for 8 weeks. At the end of this period, 6 guinea pigs were killed and examined to make sure that the animals had developed rhinitis medicamentosa. The remaining guinea pigs were randomly divided into 3 groups. In the first group, one spray-puff of 0.05% mometasone furoate aqueous nasal spray (50 microg) was applied twice daily for 14 days. In the second group, saline solution (0.9% NaCl) was applied twice daily for 14 days. No treatment was performed in the third group. At the end of the treatment period, nasal mucosal changes were evaluated by light microscopy and electron microscopy. RESULTS: After oxymetazolin application for 8 weeks, the main histologic changes were edema, congestion, proliferation of subepithelial glands, and squamous cell metaplasia. After topical mometasone furoate aqueous spray application for 2 weeks, the edema fluid was found to diminish markedly. In the saline and no treatment groups, edema and congestion continued. In these groups of guinea pigs, fibrosis has been seen in the nasal mucosa. CONCLUSION: We found that mometasone furoate nasal spray was effective against experimentally induced rhinitis medicamentosa in guinea pigs. Mometasone furoate nasal spray may have value in the treatment of patients with rhinitis medicamentosa.

Thyroid gland tuberculosis with endolaryngeal extension: a case with laryngotracheal dyspnoea.

Tuberculosis affecting the thyroid gland is a rare condition. We present the case of a 30-year-old man with thyroid tuberculosis whose presenting complaints were dyspnoea and hoarseness. There was a cystic mass in the posterosuperior right thyroid lobe extending into the paraglottic space. There was also recurrent laryngeal nerve involvement. We performed surgery and administered post-operative antituberculous treatment.

Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results.

The combined Heermann and Tos (CHAT) technique is the combination of Heermann's 'cartilage palisade tympanoplasty' and Tos's 'modified combined approach tympanoplasty = modified intact canal wall mastoidectomy'. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14-57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7-30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.

[The predictive value of assessing mastoid pneumatization in pre-dive examinations]. / Dalici muayenesinde mastoid pnömatizasyon derecesinin barotravmayi öngörmedeki degeri.

OBJECTIVES: We investigated the value of assessing the degree of mastoid pneumatization in predicting middle ear barotrauma -the most common problem in sport SCUBA divers- in comparison with that of the conventional pre-dive examination method, the Valsalva maneuver. MATERIALS AND METHODS: Thirty-four volunteer sport SCUBA divers having normal pre-dive examination findings were included. The Valsalva test was performed in all the divers. Mastoid pneumatization for each ear was calculated on a Schuller's view radiography. Pneumatization of = or <30 cm2 was accepted as poor (prone to barotrauma) and >30 cm2 was accepted as good (not prone to barotrauma). During the observation period, the divers were monitored with regard to barotrauma symptoms and signs. RESULTS: The degree of mastoid pneumatization was = or <30 cm2 in 26 ears (38%) of 16 divers (47%). The Valsalva test was negative in eight ears (12%) of six divers (18%). During a total of 1001 dives, symptomatic middle ear barotrauma occurred in 28 dives (2.8%), i.e. in 21 ears (31%) of 16 divers (47%). Of these, the degree of mastoid pneumatization predicted barotrauma in 11 (69%) divers, whereas the Valsalva test was negative in only three (19%) (p<0.05), with sensitivity, specificity, positive and negative predictive values, and efficiency being 69% and 19%, 72% and 83%, 69% and 50%, 72% and 54%, and 71% and 53%, respectively. CONCLUSION: The value of assessing mastoid pneumatization in predicting middle ear barotrauma in sport SCUBA divers is higher than that of the Valsalva test.

Relationship between mastoid pneumatization and middle ear barotrauma in divers.

OBJECTIVES/HYPOTHESIS: Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (self-contained underwater breathing apparatus) divers. STUDY DESIGN: Prospective, blinded. MATERIAL AND METHODS: Twenty-four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x-ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization. RESULTS: ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2. CONCLUSION: Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.

Effect of middle ear effusion on distortion product otoacoustic emission.

OBJECTIVES: It is well documented that children, particularly between the ages of about 2 and 6 years, exhibit a high prevalence and incidence of otitis media. Distortion product otoacoustic emissions (DPOAEs) offer great potential for clinical testing of cochlear function in children. The aim of the present study was to determine the influence of middle ear effusion and physical properties of the effusion on the recording of DPOAE. METHODS: Nineteen children (38 ears) undergoing myringotomy and/or tympanostomy tube insertion for secretory otitis media were studied. Pre-operative and post-operative first day DPOAE signal to noise ratios were compared. The results were analyzed by paired samples test and ANOVA statistical methods. RESULTS: We were found significant differences between pre-operative and post-operative first day DPOAE signal to noise at 1, 1.5, 2 and 4kHz. In addition, comparison of the pre-operative DPOAE signal to noise ratio and per-operative middle ear findings are shown significant differences between glue (thick mucous) and the other three groups (mucous, serous and no-effusion groups) at 2 and 4kHz, and between glue and no effusion group at 8kHz. Also post-operative DPOAE signal to noise ratio in relation to per-operative middle ear findings were significantly different at 2, 4 and 8kHz. The most increase of emissions at the post-operative first day was seen in ears with glue effusion at 1 and 2kHz. CONCLUSIONS: Otitis media with effusion can be monitored by DPOAE measurement pre-operatively and post-operatively. In the pre-operative evaluation, glue effusion may cause a reduction in the emissions at 2, 4 and 8kHz more than the other kind effusions.

Alternobaric vertigo in sport SCUBA divers and the risk factors.

We investigated the eustachian tube function and the incidence of alternobaric vertigo (AV) in 29 sport self-contained underwater breathing apparatus (SCUBA) divers with, or without, some possible risk factors for AV. The divers had normal audiological and otoscopic findings at the pre-dive examination. We used the nine-step inflation/deflation tympanometric test and Toynbee test for evaluation of eustachian tube function, and the Valsalva manoeuvre for patency. Information on divers, their history, and their otolaryngologic examination were obtained in the pre-dive examination. Divers performed 1086 dives (mean 37, range: 3-100) during the observation period. Four divers (14 per cent) experienced AV during five dives (0.46 per cent), (one diver experienced AV two times). It was found that having an otitis media history or eustachian tube dysfunction determined with the nine-step inflation/deflation tympanometric test before diving, or difficulty in clearing ears during diving could be important risk factors for AV in sport SCUBA divers (p <.05). Divers with such findings seem to be more prone to AV and should pay rigorous attention to the precautions for prevention of AV.

[Assessment of quality of life in patients with laryngeal cancer after surgical treatment]. / Larenks kanserli hastalarin cerrahi tedavi sonrasi yasam kalitesinin degerlendirilmesi.

OBJECTIVES: To evaluate quality of life of patients undergoing surgical treatment for larynx cancer and to compare quality of life between patients with total laryngectomy and partial laryngectomy. PATIENTS AND METHODS: Thirty-two questions were asked to patients who underwent total laryngectomy (22 subjects) or partial laryngectomy (24 subjects). These questions were based on the European Organization for Research on Treatment of Cancer questionnaires Quality of Life--C30 (EORTC-QoL-C30) and adapted to our nation. Patients with total laryngectomy and partial laryngectomy were compared according to the answers. RESULTS: We found significant statistical differences between total and partial laryngectomy patients in 12 questions. When functional disorders were evaluated, the most significant was one associated with communication. However, pain, smell disorders and increased secretion were associated with morbidity that resulted from the type of surgery. It was observed that patients with total laryngectomy were particularly affected psychologically and economically. CONCLUSION: Patients subjected to total laryngectomy experience serious physical and psycho-social disadvantages that arise from the treatment. In order to establish these negative effects and to minimize them, tools of assessment of quality of life should be developed. This assessment should be appropriate for our nation, providing information and psychological support for individuals and their families.

Laryngeal chondroma: a rare diagnosis in this localization.

Primary chondroid tumors of the larynx represent less than 1% of all laryngeal tumors. Most of them are chondromas and they often involve to the cricoid cartilage. A 31-year-old male patient applied to the oto-laryngology service with a history of dysphonia and dyspnea. Microlaryngoscopy revealed 2 cm sized, ill-defined, covered with regular mucosa, porous, and hard mass on posterior surface of crycoid cartilage in subglottic area. Following the excision of the lesion, histopathologic examination revealed as chondroma. Two years later, local recurrence was detected and the diagnosis was again chondroma. There was no complaint of the patient in last 3 and half years of follow-up. Chondroma should carefully be differentiated from chondrosarcoma and the patients should be followed for possible recurrences.

Dermoid cyst of the parotid gland: first pediatric case.

A dermoid cyst is the result of inclusion of epithelial cells along the lines of embryonic closure. Dermoid cysts of the head neck are uncommon and account for only 7% of all such cysts. They are most often reported as arising in the floor of the mouth. Dermoid cyst is rarely seen in the parotid gland. To our knowledge, there have been only six previous case reports in the English literature. Dermoid cyst of the parotid gland in pediatric patient has not been previously reported in the literature. This is the first case report concerning a dermoid cyst in a pediatric patient.