Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients.

OBJECTIVES: This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. PATIENTS AND METHODS: Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. RESULTS: Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. CONCLUSION: Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.

Endonasal endoscopic approach for recurrent nasolabial cyst.

Nasolabial cysts are rare nonodontogenic cystic lesions in the soft tissue of the midface and usually present with painless asymptomatic swelling in the nasolabial region. Surgical excision via sublabial approach is considered as the standard treatment. However, endonasal endoscopic marsupialization of the cyst is reported as an effective alternative method for nasolabial cysts. Marsupialization of the cyst is believed to integrate the nasolabial cyst into a part of the nasal cavity as an air-containing sinus. In this article, we present an endonasal endoscopic marsupialization technique in case of recurrent nasolabial cyst. To draw attention to this approach, we present our case with current literature.

[Approaches to antrochoanal polyps in adults: long-term comparative results]. / Eriskinlerde antrokoanal poliplere yaklasim: Uzun dönem karsilastirmali sonuçlar.

OBJECTIVES: This study aims to evaluate the long-term results of endoscopic sinus surgery and combined approach with Caldwell Luc procedure for the treatment of antrochoanal polyps. PATIENTS AND METHODS: Between January 2002 and December 2009, 41 patients (24 males, 17 females; mean age 34.7 years; range 14 to 78 years) were retrospectively analyzed. Patients were divided into two groups according to treatment modality: group 1 included 26 patients who underwent endoscopic sinus surgery alone and group 2 included 15 patients who underwent endoscopic sinus surgery in combination with Caldwell Luc procedure. Both groups were compared for recurrence and complication rate. RESULTS: Seventeen of 41 patients were diagnosed with right-sided lesions, while 24 patients had left-sided lesions. Recurrence was seen in three patients, including two were in the group 1 and one was in the group 2. There was no statistically significantly difference between the groups in terms of recurrence and complication rate (p>0.05). Mean follow-up was 50.5 months (range 15 to 94 months). CONCLUSION: Current approach for the treatment of antrochoanal polyps is endoscopic sinus surgery. However, combined approaches should be performed to avoid recurrences, unless removal of antral part of the antrochoanal polyp completely by endoscopic resection is possible. Selection of the combined techniques depends on the surgeon familiarity with the procedure and whether the patient is pediatric case. Combined approach with Caldwell Luc is a safe procedure in adults.

Pharyngocutaneous fistula after total laryngectomy: Less common with mechanical stapler closure.

OBJECTIVES: The aim of the study was to compare the incidences of pharyngocutaneous fistula after total laryngectomy between patients who underwent manual and mechanical suturing for pharyngoesophageal closure. METHODS: In a retrospective and prospective nonrandomized clinical study conducted at a single tertiary medical center between May 2002 and April 2009, we compared the incidence of pharyngocutaneous salivary fistula between two groups of patients after total laryngectomy. Sixty-one consecutive patients who underwent mechanical suturing with a 60-mm linear stapler (group A) were prospectively enrolled, and 121 patients who had undergone manual suturing (group B) were retrospectively reviewed. RESULTS: The groups were similar in terms of age, gender, comorbidities, TNM (tumor, node, metastasis) stage, and laryngeal tumor extension. The incidence of pharyngocutaneous salivary fistula was 4.9% in group A and 19.8% in group B (p = 0.014). CONCLUSIONS: Mechanical stapler closure of the pharynx after total laryngectomy was associated with a significant reduction in the incidence of pharyngocutaneous fistula compared with manual suture in selected cases.

[The evaluation of cordectomy cases without tracheotomy in laryngeal cancer]. / Larenks kanserlerinde trakeotomisiz kordektomi olgularinin degerlendirilmesi.

OBJECTIVES: We evaluated the technique of laryngofissure cordectomy without tracheotomy in patients with T1a laryngeal carcinoma. PATIENTS AND METHODS: Twelve male patients (mean age 55 years; range 47 to 68 years) who were diagnosed with T1a laryngeal carcinoma and treated with cordectomy without tracheotomy between January 2005 and March 2008 in our clinic were evaluated with retrospective review of medical charts. They were all treated with laryngofissure and cordectomy. The cord with carcinoma was excised with the inner perichondrium of thyroid cartilage and surgical margins were examined hystopatologically with frozen section. Postoperative oncologic and functional results were evaluated. RESULTS: None of the patients were treated with preoperative or postoperative tracheotomy. Oral nutrition was initiated on the 3rd postoperative day and the patients were discharged. No tumor recurrences were seen in the postoperative follow-ups. CONCLUSION: Although the surgical area is slightly restricted due to the use of entubation tube, cordectomy without tracheotomy had better functional results and the oncological results were unchanged compared to cordectomy with tracheotomy. Since the procedure is without tracheotomy, psychological adaptation period of the patients was shorter compared to the patients treated cordectomies with tracheotomy.

Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy.

We investigated general and physical predictors of difficult laryngeal exposure in patients undergoing suspension laryngoscopy; 93 patients were included in this prospective study. The patients were classified as difficult laryngeal exposure group or non-difficult laryngeal exposure group based on the laryngeal view in suspension laryngoscopy. Twelve parameters (age, sex, body mass index, neck circumference, full mouth opening, modified mallampati index, hyoid-mental, thyroid-mental, horizontal thyroid-mental, vertical thyroid-mental, sternum-mental distance) that could predict difficult laryngeal exposure were evaluated. Of 93 patients, 22 had difficult laryngeal exposure. Cormack-Lehane score, neck circumference, body mass index, modified mallampati index, hyoid-mental, thyroid-mental, vertical thyroid-mental, and sternum-mental distance showed significant correlation with difficult laryngeal exposure. Based on the multivariate analysis, neck circumference superior to 40 cm, hyoid-mental and sternum-mental distance with respectively a value less than 6.05 and 13.9 cm were independently associated with difficult laryngeal exposure. Muscular neck, hyoid-mental and sterno-mental distance should be considered clinical predictors of difficult laryngeal exposure. Measurements of physical variables at full extension position of the neck are more useful and reliable predictors than neutral position for the risk of difficult laryngeal exposure.

[Evaluation of superior semicircular canal dehiscence in patients with vertigo and tinnitus]. / Vertigo ve tinnituslu hastalarda süperior semisirküler kanal dehissansinin arastirilmasi.

OBJECTIVES: The aim of the study was to investigate the presence of superior semicircular canal dehiscence (SSC) in patients with unknown etilogy of vertigo/tinnitus. PATIENTS AND METHODS: This study was performed prospectively between December 2007 and March 2008. Fifty five patients (23 males, 32 females; mean age 44.5; range 36 to 74 year) with complaints of vertigo and/or tinnitus, of which we couldn,t establish the etiologies, were included in the study. Control group was consisted of 15 patients who didn,t have complaints of vertigo and/or tinnitus. A high resolution temporal bone computed tomograpy (CT) scan (1 mm slice thickness) was performed in all study groups (patients and controls). RESULTS: Thirty nine subjects (72%) had normal odiometric findings. Mild conductive hearing loss was present in 12 (22%) subjects. Two (3%) of the patients had moderate conductive hearing loss and the other two subjects (3%) had mixed type hearing loss. High resolution temporal bone CT scan revealed that 35 (65%) subjects had dehissence around SSC otic capsule whereas 20 (35%) remaining patients yielded no dehissence. Twenty one of 35 patients (60%) with dehissence at SSC had minimum defect and 14 patients (40%) had significant defect. Bilateral defect was present in nine (64%) of 14 patients with significant defect but none of the subjects with minimum defect showed bilateral involvement. None of the control subjects exhibited SSC dehissence with CT imaging. CONCLUSION: Semicircular canal dehissence was found in 65% of the patients with unknown etiology of the vertigo and tinnitus. Physicians should evaluate the SSC dehissence in patients with vertigo and tinnitus as an etiologic factor.

Evaluation of prognostic factors and middle ear risk index in tympanoplasty.

OBJECTIVE: The aim of this study was to examine the role of the prognostic factors and middle ear risk index on the success of tympanoplasty. STUDY DESIGN: Case series. SUBJECTS AND METHODS: The charts of 231 patients who underwent tympanoplasty operations between 2002 and 2007 were reviewed. Prognostic factors such as age, sex, presence of systemic diseases, location and size of perforation, duration of dry period, presence of myringosclerosis, presence of septal and conchal pathology, operation type, and status of the opposite ear and middle ear risk index were investigated. RESULTS: The overall success rate was 74.4%. Multivariate analysis was carried out on significant prognostic factors to obtain independent variables and yielded the following results (95% CI): size of the perforation (<50%) (OR:8.11), healthy opposite ear (OR:5.64), more than 3 months dry period (OR:2.21), absence of myringosclerosis (OR:4.01) and low middle ear risk index (OR:87.1). CONCLUSION: Size of the perforation(<50%), healthy opposite ear, absence of myringosclerosis, more than 3 months dry period, and low middle ear risk index were found to be significant independent prognostic factors.

Efficacy of nasal corticosteroids alone or combined with antihistamines or montelukast in treatment of allergic rhinitis.

OBJECTIVE: Topical corticosteroids are recommended as initial therapy in allergic rhinitis (AR) patients. We investigated clinical efficacy of monotherapy with topical steroid and combined therapy in AR patients. METHODS: Ninety-five AR patients sensitive to grass pollens according to skin prick test results were enrolled in this placebo-controlled and open study. Patients were divided to four groups. Group-1 received only intranasal mometasone furoate (MF) 200microg (n=25), group-2 received intranasal MF and oral desloratadine (DLR) 5mg (n=25), group-3 received intranasal MF and oral montelukast (MSK) 10mg (n=25), group-4 received only placebo (n=20). Efficacy was assessed on the basis of total nasal symptom scores, rhinoconjunctivitis quality of life questionnaire scores and nasal inspiratory peak flow rates. RESULTS: All groups that received treatment had better results when compared to the placebo group. Significant improvement in total nasal symptom scores was first evident at the end of the 2nd week in group-2. Group-3 had better results than those of the other groups at the end of the 1st month (p<0.05). Quality of life scores were significantly better in group-2 and -3 when compared to those in group-1 (p<0.05). CONCLUSION: Although corticosteroids are the mainstay of treatment in allergic rhinitis, montelukast may be considered as an additional agent especially in treatment of patients with impaired quality of life and it may be used to reduce nasal symptom scores.

[Evaluation of depth of invasion and tumor diameter in relation to tumor localization in laryngeal cancer]. / Larenks kanserlerinde tümör yerlesimine göre invazyon derinligi ve tümör çapinin degerlendirilmesi.

OBJECTIVES: We investigated the relationship between tumor localization and depth of tumor invasion and tumor diameter. PATIENTS AND METHODS: Neck dissection specimens of 70 patients (mean age 61+/-10 years, range 38 to 77 years) who underwent laryngectomy for squamous cell carcinoma of the larynx were histopathologically re-examined with regard to the number and localization of metastatic lymph nodes, depth of tumor invasion, and tumor diameter. Three tumor groups (supraglottic, glottic, and transglottic) were compared with respect to depth of tumor invasion, tumor diameter, metastatic lymph nodes, and T-stage. RESULTS: The overall mean depth of tumor invasion was 7.06 mm, being 7.76 mm, 7.05 mm, and 4.06 mm in supraglottic, transglottic, and glottic tumors, respectively. Compared to glottic tumors, depth of tumor invasion and tumor diameter were significantly higher in supraglottic and transglottic tumors (p<0.05). Depth of invasion showed a significant correlation with tumor diameter (p<0.05), whereas there was no correlation between depth of invasion and lymph node metastasis (p>0.05). In supraglottic tumors, depth of invasion significantly increased in parallel with T-stage (p<0.05). In transglottic and glottic tumors, however, there was no correlation between T-stage and depth of invasion (p>0.05). CONCLUSION: Our data show that depth of tumor invasion is related with tumor location and diameter in laryngeal cancers.

[Pharyngocutaneous fistula after total laryngectomy: incidence and analysis of risk factors]. / Total larenjektomi sonrasinda farengokutanöz fistül sikligi ve risk faktörlerinin analizi.

OBJECTIVES: We evaluated the incidence and predisposing risk factors of pharyngocutaneous fistulas that develop after total laryngectomy. PATIENTS AND METHODS: The records of 210 patients (19 females, 191 males; mean age 60+/-9 years; range 39 to 77 years) who underwent total laryngectomy were retrospectively reviewed. Thirteen predisposing risk factors were evaluated (age, sex, pre-and postoperative anemia and hypoalbuminemia, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, hypertension, preoperative tracheotomy, tumor stage and localization). RESULTS: Pharyngocutaneous fistulas were found in 41 patients (19.5%). The mean duration for fistula formation was 7.7 days (range 2 to 16 days). Coronary artery disease (p=0.00), postoperative hemoglobin (p=0.000) and albumin (p<0.005) levels lower than 10.7+/-1.2 g/dl and 3.0+/-0.5 g/dl, respectively, were found to be significant risk factors for fistula formation. CONCLUSION: Fistula formation is the most frequent complication in laryngectomy patients. To prevent fistula formation, special attention should be paid to surgical technique and postoperative care especially in patients who have coronary artery disease, anemia, and hypoalbuminemia.

[Expression of Ki-67 and p53 in laryngeal squamous cell carcinomas]. / Skuamöz hücreli larenks kanserinde Ki-67 ve p53 ekspresyonu.

OBJECTIVES: The aim of this study was to investigate the expression of p53 tumor suppressor gene and Ki-67 antigen in laryngeal squamous cell carcinoma and its relation to conventional prognostic indicators. PATIENTS AND METHODS: p53 and Ki-67 expressions were evaluated in surgical specimens of 37 patients (34 males, 3 females; mean age 57.2 years; range 35 to 75 years) with squamous cell carcinoma of the larynx. Immunohistochemical studies were performed in routinely fixed and paraffin-embedded tissue sections using the immunoperoxidase technique and monoclonal antibodies. RESULTS: The tumors were well-, moderately, and poorly differentiated in 5, 24, and 8 patients, respectively. Ten patients had lymph node metastasis, nine patients had vascular invasion, and 15 patients had neural invasion. Ki-67 and p53 nuclear staining was detected in 31 (83.8%) and 15 (40.5%) tumors, respectively. The incidence of Ki-67 expression was higher in patients with lymph node metastasis, but this did not exhibit significance. Neither p53 nor Ki-67 immunoexpression was in significant association with conventional clinicopathological parameters (p>0.05). CONCLUSION: These data indicate that p53 and Ki-67 are not correlated with conventional prognostic parameters in squamous cell carcinoma of the larynx.

[The relationship between skin test results and serum eosinophilic cationic protein, nasal eosinophilia, and total IgE values in patients with allergic rhinitis]. / Alerjik rinitli hastalarda deri testi ile serum eozinofilik katyonik protein, nazal eozinofili ve total IgE arasindaki iliski.

OBJECTIVES: We investigated the relationship between positive skin test results and serum eosinophilic cationic protein (ECP), nasal eosinophilia, and total IgE levels in patients with allergic rhinitis. PATIENTS AND METHODS: The study included 36 patients with allergic rhinitis (26 females, 10 males; mean age 32.8 years; range 17 to 60 years) and with a positive skin test result. Serum ECP, nasal eosinophilia, and serum total IgE levels were assessed and compared with a control group of 18 healthy volunteers (15 females, 3 males; mean age 30.3 years; range 20 to 49 years) and correlation was sought with skin test results. RESULTS: Twenty-five patients were sensitive to only seasonal, four patients to only perennial, and seven patients to both seasonal and perennial allergens. Twelve patients were sensitive to one allergen, seven patients to two, and 17 patients to three or more allergens. Compared to controls, the mean serum ECP, nasal eosinophilia, and serum total IgE values were significantly higher in the patient group (p<0.05). These parameters did not show significant relationship with the type and number of allergens (p>0.05). CONCLUSION: Serum ECP, nasal eosinophilia, and serum total IgE levels increase in patients with allergic rhinitis. These parameters are not affected by sensitivity to seasonal or perennial allergens.

[Castleman's disease of the cervical region: a case report]. / Servikal bölgede Castleman hastaligi: olgu sunumu.

Castleman's disease is a rare disorder characterized by massive proliferation of the lymphoid tissue due to an unknown cause. Two clinical types (localized, multicentric) have been described with three histological variants (hyaline-vascular, plasma cell, and mixed type). A 47-year-old female patient was referred to our department because of a swelling in the posterior cervical region. Fine-needle aspiration biopsy was suggestive of lymphoma. Total excision of the mass was performed under general anesthesia with intraoperative frozen section examination. Histopathologic diagnosis was Castleman's disease of hyaline-vascular type. Castleman's disease should also be considered for suspicious masses in the neck.

Effects of the electromagnetic field of mobile telephones on hearing.

The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. Anatomically, the ear is in close proximity to the mobile telephone during use. Hearing loss due to mobile telephone use has not been described in the medical literature; however, if there is a subtle cochlear involvement, it might be detected by means of changes in evoked otoacoustic emissions (OAEs). Thirty volunteers with normal hearing were exposed to mobile telephone EMFs for 10 min and evoked OAEs were measured before and after exposure. No measurable change in evoked OAEs was detected and none of the subjects reported a deterioration in hearing level. To the best of our knowledge, this is the first study on the effects of EMFs emitted by mobile telephones on hearing. It was concluded that a 10-min exposure to the EMF emitted from a mobile telephone had no effect on hearing, at least at outer ear, middle ear and cochlear levels.

The relationship between the concha bullosa, nasal septal deviation and sinusitis.

OBJECTIVES: To evaluate the possible relationship between concha bullosa, nasal septal deviation and sinusitis. PATIENTS AND METHODS: Paranasal sinus computed tomography scans of patients suffering from rhinosinusitis were examined. Fifty-four patients with concha bullosa were included in the study. The relationship between concha bullosa, nasal septal deviation and sinusitis was investigated. RESULTS: A statistically significant relationship between unilateral concha bullosa and nasal septal deviation was found (p < 0.01). The relationships of unilateral and bilateral concha bullosa with sinusitis, and bilateral concha bullosa with nasal septal deviation were not statistically significant (p > 0.05). CONCLUSION: In order to define the relation between the concha bullosa, nasal septal deviation and sinusitis, more detailed investigations are needed.

Autoclaving the ossicles provides safe autografts in cholesteatoma.

OBJECTIVE: The choice of the graft in ossicular chain reconstruction during middle ear surgery for cholesteatoma is a subject still discussed on. In order to clarify the discussion of reuse of the autologous ossicles obtained during middle ear surgery for cholesteatoma, we evaluated the probability of residual disease histologically and the safety of the ossicles after autoclavization, the most promoting alternative method to eradicate residual cholesteatoma and infection on them. METHODS: The specimens used in this study were eroded twenty-seven ossicles (22 incuses, 5 malleoli) which were removed from the 27 consecutive patients operated because of cholesteatomatous middle ear disease. They were grouped as follows: Group 1, Fifteen ossicles examined histopathologically directly. Group 2, Five ossicles autoclaved for 20 min at 134 degrees C and then examined histopathologically. Group 3, Five ossicles autoclaved for 20 min at 134 degrees C after mechanical surface cleaning by a fine diamond drill, examined histopathologically. Group 4, Two ossicles removed from two different patients were placed in their mastoid cavities in order to be examined after access in the second-look operation. While one ossicle was only autoclaved, the other was mechanically cleaned by a drill before autoclavization (for 20 min at 134 degrees C). The ossicles were examined histopathologically after the removal at the second stage operation performed 12 months later. RESULTS: In Group 1, all ossicles showed evidence of periosteal thickening. Additional findings were surface cholesteatoma or epithelia in 13 ossicles, surface inflammation in 12 ossicles, granulation tissue in 10 ossicles, osteitis in six ossicles. In Group 2, all five ossicles had preserved their lamellar structure but, no vital cells were seen. The lacunes that had the osteocytes was almost completely empty. The inflammatory cells were eliminated from the ossicles. In Group 3, ossicles were found well preserved with their lamellar structures and contours, with empty lacunes and eliminated inflammatory cells. In Group 4, in two ossicles of this group the lacunes were replaced by the new migrated viable osteocytes with evidence of new bone formation and neovascularisation. No new inflammatory focus or epithelia were found on the surfaces of the ossicles. The shape and the contour of the ossicles remained unchanged. CONCLUSION: In cholesteatoma surgery, ossicles with minimal erosion and adequate thickness can be used after autoclavization. In this study, it was observed histopathologically that the autoclaving autologous ossicles before ossiculoplasty in cholesteatomatous middle ear is a safe and reliable method.

Kimura's disease: two case reports with a review of the literature.

Kimura's disease is an uncommon, chronic inflammatory disorder of unknown etiology. The disease usually presents as a massive subcutaneous swelling with predilection for the head and neck region in young men. Morphologically, the lesions are characterized with lymphoid follicles, intensive aggregations of eosinophils, vascular proliferation and fibrosis. Laboratory analyses detect hypereosinophilia and elevated total IgE in the blood. We present two cases of Kimura's disease in which lymphadenopathy and cutaneous nodules were the main findings. We reviewed the literature on Kimura's disease.

Metastatic spread of occult papillary carcinoma of the thyroid to the parapharyngeal space: a case report.

Metastasis from thyroid carcinomas to the parapharyngeal space is very rare. A forty-year-old male presented with progressive dysphagia and enlargement in the right upper neck. Examination showed medial displacement of the right palatine tonsil and the lateral oropharyngeal wall. A firm, submucosal mass measuring 4 x 3 cm was palpated. Computed tomography revealed a hypodense and heterogenic parapharyngeal mass with a calcified border. The mass was totally removed by a transcervical approach. Although frozen-section diagnosis was a benign lesion, histopathologic evaluation showed metastasis of papillary thyroid carcinoma to the parapharyngeal lymph nodes. Total thyroidectomy and bilateral selective neck dissection were performed, after which the tumor turned out to be papillary microcarcinoma (0.8 x 0.8 cm) in the right upper lobe of the thyroid gland. No locoregional recurrences or distant metastasis were observed during a three-year follow-up. The differential diagnosis of parapharyngeal masses should include metastatic thyroid carcinomas, for which a lymphatic route has been suggested between the thyroid gland and the parapharyngeal lymph nodes.