Volume 2 Issue 2 (2012)

Objective: In this study, we aimed to evaluate the anatomical variations around frontal recess and the influence of variations on frontal rhinosinusitis (FR) in healthy individuals and in cases with frontal rhinosinusitis (FR).

Methods: A total of 61 cases that applied to our outpatient center were grouped according to: cases with ear complaints (Group I, control group), cases with sinonasal symptoms but FR findings (Group II), and cases with both sinonasal and FR findings (Group III). All cases underwent paranasal computerized tomography (CT) with parasagittal reconstruction. All scans were assessed for the presence of fronto-ethmoidal cells, anatomical variations, osteomeatal complex diseases and sinus opacifications.

Results: In all sides of study, the rate of fronto-ethmoidal cell was 20.9%. When cases with sinonasal signs (Groups II and III) and control group (Group I) were compared, intersinus septum (p=0.01) and agger nasi cells (p=0.001) were statistically significant. In sides with frontal recess disease (+) and/or frontal sinus opacification (+), Kuhn type III (p=0.03) fronto-ethmoidal cells and bulla frontalis (p=0.02) were significantly increased, and Kuhn type IV fronto-ethmoidal cell (both sides) was present only in cases with frontal recess disease (+) and/or frontal sinus opacification (+). When the role of fronto-ethmoidal cells on frontal recess disease and/or frontal sinus opacification were assessed, Kuhn Type III cell was 4.55 times (%95 GS: 0.560-12.196) more effective.

Conclusion: Kuhn type III and IV fronto-ethmoidal cells and bulla frontalis may have a role in FR. The radiological evaluation of anatomical variations around frontal recess with parasagittal sections was useful.

Objective: The aim of this study is to reveal the role of matrix metalloproteinase-9 in the pathogenesis of nasal polyps by comparing its levels in normal healthy subjects, and patients with nasal polyps. Our second aim is to demonstrate the correlation (if any) between white blood cell counts, age, gender of the patients presence of asthma, and MMP-9 levels.

Methods: Serum samples of patients were obtained and kept at -70°C. Quantikine kit (R&D System Inc, Minneapolis, MN, USA) micro-ELISA (Enzyme-Linked Immunosorbent Assay) method was used to estimate plasma matrix metalloproteinase-9 levels. Serum matrix metalloproteinase-9 values of the control, and the patient groups were compared. The correlation between age, gender of the study subjects, white blood cell counts and the presence of asthma was investigated.

Results: Serum matrix metalloproteinase-9 values were significantly higher in patients with nasal polyps relative to the control group. White blood cell counts in the group with nasal polyps were higher without any statistically significant difference between the groups. Any correlation between matrix metalloproteinase-9 values, age, and gender was not found. In addition, any correlation was not detected between concomitant asthmatic disease and matrix metalloproteinase-9 values.

Conclusion: Significantly, higher matrix metalloproteinase-9 values in patients with nasal polyps support our opinion suggesting the role of this protein in the etiopathogenesis of this disease.

Objective: Our aim is to emphasize the efficacy of endoscopic endonasal approach in patients diagnosed as inverted papilloma with limited histopathologic data.

Methods: Forty patients who had preoperative diagnosis of inverted papilloma in our clinics, and operated between October 2002 and May 2012 were retrospectively analyzed. These patients had undergone medial maxillectomies using endoscopic transnasal (n=38) or external lateral rhinotomy (n=2) approach. The purpose of preferring external approach for lateral rhinotomy was that one of the patients was diagnosed as epidermoid carcinoma, and the other patient had intense scar tissue due to the previous operation performed in another medical center with resultant distorted normal anatomic structure.

Results: Mean age of 40 patients operated for the diagnosis of inverted papilloma was 54±9.43 (range 27 to 81) years. While the main complaint of the patients was nasal stuffiness, the other complaints were rhinorrhea, headache, postnasal drainage, olfactory problems, mass lesion protruding out from nasal cavities, sense of pressure, and pain on face, nosebleed, snoring, and dry mouth. Among 40 patients 55 different anatomic regions were affected, and in some patients the tumor was originated from 2 or 3 regions. Any problem was not encountered in 38 patients whom we operated using transnasal endoscopic method during an average postoperative follow-up period of 55.8 (range 2 to 112) months.

Conclusion: Transnasal endoscopic surgery is an effective and safe method in selected cases with inverted papilloma.

Objective: In this study the effects of intranasal rhinophototherapy on symptoms of allergic rhinitis, physical examination findings, and quality of life of our patients with allergic rhinitis have been investigated.

Methods: Our study group consisted of the patients followed up for at least 2 years with diagnosis of allergic rhinitis in our outpatient clinic. Among them the first 100 patients who underwent nasal phototherapy from January 2006 on, and followed up by us at least one year constituted our study group. The patients presenting with complaints of rhinorrhea, nasal itching, and stuffiness had undergone all physical examinations of Ear Nose and Throat system. Specific IgE levels were determined, and skin Prick tests were performed.

Results: Our study group consisted of 32 male and 69 female patients with a median age of 35.09 (range 18 to 52) years. When the responses to "The Rhinoconjunctivitis Quality of Life Questionnaire" for adults were evaluated globally, it can be concluded that phototherapy method applied had improved quality of life markedly at the end of one month, but the level of improvement did not remain the same up to 3rd months, on the contrary it decreased, and at end of one year it attenuated significantly. In the short-term the most apparent response to phototherapy was observed in nasal symptoms, restricted activities, and sleep parameters. However, ocular and non-allergic symptoms improved minimally.

Conclusion: As an outcome of our study, it was detected that phototherapy improved symptoms of allergic rhinitis, and physical examination findings, and effected quality of life scores favorably. However in the long run, it was concluded that adequate responses could not be obtained.

Objective: Endolaryngeal microsurgery is the fundamental treatment of vocal cord polyps. After surgical treatment, the changes in the voice quality can be measured by various scales that examine the audio perception of the voice and/or by objective voice analyses done with the help of a software program. The aim of this study was to evaluate the vocal performance of the patients with vocal cord polyps operated with endolaryngeal microsurgery.

Methods: In this study, Vocal Performance Questionnaire and acoustic voice analyses were performed on 40 patients with vocal cord polyps operated with endolaryngeal microsurgery and the results were compared statistically.

Results: When pre-, and postoperative comparisons of the parametres of the cases were evaluated statistically by Vocal Assessment program, a statistically significant decrease in postoperative Jitter (%), Shimmer (%), Fo tremor (Hz), noise energy (dB), harsh voice, hoarse voice, breathy voice parameters, while a statistically significant increase in percent voiceless, and voiced time during habitual phonation, fundamental frequency change interval (Hz) was detected. However in statistical comparisons of parameters using Real Analysis Program, a statistically significant decreases were detected in percent voiceless time during habitual phonation, fundamental frequency change interval (Hz), and percent voiceless time values between the lowest-, and the highest-pitched sounds that could be recorded during phonation after the treatment, while statistically significant increases in posttreatment percent voiced time during habitual phonation, percent voiced time values between the lowest-, and the highest-pitched sounds that could be recorded during phonation, and fundamental frequency change interval (Hz) were demonstrated.

Conclusion: It has been conceived that the physiology of the larynx can be protected with a successful surgical excision and the phonatuary functions of the vocal cords can be returned to normal.

Benign lesions of vocal cord are the most prevalent pathologies following inflammation. The most commonly described symptom is hoarseness and in rare instances, a patient may develop a shortness of breath in large lesions. Management process includes the evaluation of etiopathology, preferably using a conservative treatment approach. Surgery may be considered as a treatment option when conservative treatment measures fail. There are various diagnostic categories for benign vocal cord lesions. In this article, the most common benign vocal cord lesions are summarized with an overview of up-to-date treatment options.

The larynx as a site of tuberculosis represents less than 1% of the total of this disease. The incidence of laryngeal tuberculosis is increasing worldwide. Recent studies have described a change in the clinical features of laryngeal tuberculosis. Laryngeal tuberculosis is often misdiagnosed, as it is uncommon. Upper aerodigestive tract tuberculosis is difficult to differentiate from carcinoma; thus, tissue biopsy is necessary for a definite diagnosis. We present six recent cases of laryngeal tuberculosis which its diagnosis was made in all cases through laryngeal biopsy. All were male and their ages ranged from 42-60 years. The prominent presenting symptom was hoarseness. Four patient showed ulcerative lesions, 2 showed pseudo-tumoral images in the larynx. Histopathological results showed granulomatous infectious disease. Chest radiography showed heterogenous density in four of the cases, reticulonoduler density in one, and cavitary, infiltrative lesions in one case. Patients were free of disease after 9 months of tuberculostatic therapy, and laryngeal appearances were almost normal.

Giant mucoceles of the frontal sinus are rare but their recognition is important in the differential diagnosis of proptosis and fronto-orbital lesions. We describe a patient with frontal giant mucocele with intracranial as well as orbit and ethmoid sinus involvement. A 53-year-old male was admitted with headache, right exophthalmos and ophthalmoplegia. Computed tomography and magnetic resonance imaging demonstrated a giant frontal sinus mucocele with extension into the left anterior cranial fossa and orbit. The mucocele was treated with a transcranial and endoscopic transnasal approach.