Volume 3 Issue 2 (2013)

Though there are a lot of causes of vocal cord paralysis, such as trauma, cancer and surgery; idiopathic cases are also found. Vocal cord paralysis can be also seen in cases of mediastinal mass or tuberculosis which cause mediastinal lymphadenopathy. In this paper, a patient complaining of hoarseness with the diagnosis of left vocal cord paralysis was presented. Thoracic computed spiral tomography showed conglomerated mediastinal lymphadenopathy and biopsy was reported as granulomatous inflammation. Antituberculostatic therapy was administered to the patient and his follow-up procedures are continuing currently.

In laryngectomized patients, foreign body aspiration into the tracheobronchial system is an emergency condition and may cause acute respiratory distress; although it is very rare. In this case report, symptomatology, diagnostic evaluation and treatment modality of a laryngectomized patient who had inner cannula aspiration into the tracheobronchial system were presented.

Allergic rhinitis (AR) affects the individual's quality of life, psychological well being, cognitive functions and sleep quality. Patients often experience annoying symptoms, mood disorders, decreased work productivity and even loss of work. In pediatric patients undiagnosed or untreated/undertreated AR may be related with learning difficulties which may have an important impact on community's present and future life. AR medication, health care utilization, loss of productivity and work is also related with a cost which is also important for patients, their families and society's economic status. All these factors rendered the disease a social aspect. This article aimed to present the social problems generally related to allergic rhinitis.

Objective: To investigate the effects of the chronic hypertrophic adenotonsillitis on olfaction and quality of life.

Methods: Pediatric patients, aged 7-8 years, were prospectively included in three groups; Group I- Adenotonsillar diseases (n=15), Group II- Control (n=15) and Group III- Postoperative group (n=15). Patients were evaluated with the Sniffin' Sticks 12 item smell identification test and obstructive sleep disorder-6 (OSD-6) quality of life survey.

Results: Total smell identification (SI) scores were 6.93±1.75 in the adenotonsillar disease, 8.73±1.10 in the control and 7.67±1.59 in the postoperative groups, respectively. Total SI score in the adenotonsillar disease group was significantly lower than the control group (p<0.05).

Conclusion: Adenotonsillar diseases affect both quality of life and smell function. Six months after surgery quality of life reaches normal standards. Smell function is observed to have partially recovered by the sixth month. This situation may be due to obstructive symptoms resolving in the early postoperative period, while symptoms related to mucosal or inflammatory pathologies recover more slowly.

Objective: To prospectively investigate the effect of isotretinoin therapy on the functions of hearing and to show the relationship between concurrent triglyceride levels.

Methods: A total of 47 patients who were admitted to our dermatology clinic between February 2011 and June 2011 for the treatment of acne using 0.5 mg/kg isotretinoin were included in this study. All the patients were started on 0.5 mg/kg/day isotretinoin depending on their tolerance of the drug. Details such as age, sex, dose of isotretinoin for the first 6 months, monthly pretreatment and posttreatment, and ALT, AST, triglyceride and total cholesterol values were recorded. There were 33 females and 14 males in the study group.

Results: Audiometric evaluations made prior to treatment with isotretinoin, levels of PTA1 and PTA2 were 11.96 and 12.59, respectively, these were compared with the results of tests carried out after the treatment and pre- and posttreatment values of PTA1 and PTA2 were found to be the same, 1 month after the treatment, drug use did not effect hearing. PTA 1 value after 3 months was 12.16 and PTA 2 value was 13.85. These values are compared to pretreatment values and PTA2 PTA1 both were decreased. However, in the third month the threshold decrease was not statistically significant (p>0.05). PTA1 and PTA2 values after the sixth month were 12.25 and 12.96, this decrease was statistically significant compared with pretreatment values (p<0.05).

Conclusion: Treatment with isotretinoin increased total cholesterol and triglyceride levels. Isotretinoin reduced pure-tone average hearing at the end of the 6th month and this effect was related to the increases in the levels of triglycerides and total cholesterol.

Objective: Preoperative and postoperative hearing results were compared in patients undergoing hearing reconstruction through open mastoidectomy with type III tympanoplasty method in our center.

Methods: A total of 46 patients with chronic suppurative otitis media, who had undergone ossicular chain reconstruction by type III tympanoplasty with canal wall down mastoidectomy (CWDM) operation between January 2005 and 2009 were enrolled in the trial. The preoperative status of ossicular chain, the reconstruction methods on the ossicles, as well as the materials used in the reconstruction and the presence of stapes superstructure were recorded. Postoperative hearing gain of patients was evaluated by pure tone audiometry on an average of 6th months following surgery.

Results: Among enrolled patients, 18 were females (39%) and 28 were males (61%). In 30 patients (65%), cholesteatoma was seen to have extended to the attic, antrum, supratubal recess and sinus tympani, while in 16 cases, cholesteatoma was determined to have partly invaded the mastoid cavity and mesotympanum. A polypoid tissue, arising from mucosa of middle ear and sagging into the external ear canal was detected in 6 patients (13%). While the preoperative and postoperative mean air-bone gaps were determined as 33.96 dB and 28.21dB, respectively. Preoperative and postoperative audiological examinations revealed an air-bone gap of £25 dB in 26.1 and 47.8% of the cases respectively.

Conclusion: Type III tympanoplasty operation with canal wall down mastoidectomy provides eradication of the disease with cholesteatoma and enables reconstruction of hearing.

Objective: Our aim was to determine the treatment results, side effects and the prognostic factors affecting survival in patients with larynx cancer treated in our clinic.

Methods: Data of a total of 90 patients with larynx carcinoma were included in the study. The patients’ performance scores were evaluated according to the Eastern Cooperative Oncology Group (ECOG) system.

Results: Eighty-seven (97%) patients were male and three patients (3%) were female. The median age of the patients was 59 (37-86) years. Early-stage, locally advanced stage, and metastatic disease were detected in 43, 55, and 2% of the patients, respectively. Laryngeal cancers were observed in the glottic (53%), and supraglottic (47%) regions. Performance score (p=0.022), grade (p=0.033), lymph node metastasis (p=0.001), T stage (p=0.034) and disease stage (p=0.007) were significantly unfavourable in supraglottic cancers compared to glottic cancers. Recurrence was observed in 17% of the patients in a median 15 (range: 5-96) months. Distant metastasis was observed in 12% of the patients in a median 17 (range: 1-155) months. The factors affecting survival were the presence of comorbidities (p=0.032), performance status (p=0.022), hemoglobin level (p=0.003), T stage (p=0.006), disease stage (p=0.011), and weight loss (p=0.002). When RT- and CRT-associated side effects were compared, the incidence of adverse effects such as mucositis (p<0.001), nausea/vomiting (p<0.001), weight loss (p=0.005), neutropenia (p=0.001), and anemia (p=0.003) in patients under chemoradiotherapy was significantly higher than those associated with radiotherapy.

Conclusion: Hemoglobin level, T stage, presence of comorbidity and weight loss were independent prognostic factors.

Objective: The objective of this study was to investigate the current information-seeking behaviors of ENT physicians and ENT trainees in Turkey and their willingness to learn and acquire evidence-based practice skills.

Methods: A cross-sectional survey was carried out by distribution of a questionnaire to 740 otolaryngologists employed in Turkey who attended a national otolaryngology meeting in October 2010. Five-hundred forty-three completed questionnaires were gathered. The questionnaire was created as four questions including expectations from academical meetings valuation scoring from one to five points was used to evaluate these four questions in the questionnaire.

Results: There was a statistical correlation between the number of years of experience and willingness to acquire information mastery skills. When the responses to the question &quot;Which meetings do you believe that you will benefit mostly?&quot; were analyzed, they preferred to watch surgical operations in international workshops or participate in courses abroad, instead of attending interactive surgical operations or symposiums on a single topic. Based on the responses to the question 'Which meetings or applied courses do you find attractive to participate?&quot; they preferred to attend &quot;courses of cadaver dissection&quot; in lieu of live-interactive surgical operations.

Conclusion: Most otolaryngologists in Turkey not only believed that it is essential to acquire specific interactive information from the meetings, but also they were convinced that effective education depends on evidence-based practice with cadavers. Most were willing to increase these information and skills. Results of our article shed light on the points to be considered in educational process of ENT specialists.

Objective: The aim of this study was to investigate the effect of surgical treatment of Reinke's edema on voice quality. The changes in voice quality caused by surgical treatment were evaluated by using voice performance questionnaire and acoustic voice analysis before and after surgery.

Methods: Vocal Performance Questionnaire and acoustic voice analyses with the help of Dr. Speech (Drs Tiger Inc., Seattle, WA, USA) software were performed preoperatively and at one month postoperatively in 21 patients with Reinke's edema who had received surgical therapy.

Results: Reinke's edema was bilateral in all patients. According to the results of vocal performance questionnaires and acoustic voice analyses, the voice quality of patients improved significantly after surgery. At the end of the six month follow-up, the recurrence was detected only in one (4.7%) patient.

Conclusion: In patients with Reinke's edema, the functional properties of vocal folds and the voice quality of patients can be successfully improved by surgical treatment.

Objective: Sudden hearing loss is a sensorineural hearing loss with an unknown etiology at ≥30 dB which appears in 3 days or within a shorter period of time and obstructs three successive frequencies. Our objective in this study is to assess the effectiveness of the combination of classic therapy and intratympanic steroid treatment in the management of idiopathic sudden sensorineural hearing loss.

Methods: One hundred and forty patients diagnosed with idiopathic sudden sensorineural hearing loss in our clinics between February 2010 and June 2012 were separated into 2 groups. Seventy-six patients [37 women (48.68%) and 39 men (51.32%)] with a mean age of 45.1±14.16 years managed with a combination of classic sudden hearing loss and intratympanic steroid treatment (Group 1) and 64 patients [34 women (53.18%) and 30 men (46.82%)] with a mean age of 47.6±17.74 years managed with only classic sudden hearing loss treatment (Group 2) were included in the study. One month after the study, pure-tone averages and speech discrimination scores of the patients were compared with those obtained 1 month before the treatment.

Results: Pure-tone average of the intratympanic-steroid treatment group was found to be 68.28 dB before the treatment where in the other group it was 67.21 dB without any statistically significant difference between groups. When followed-up 1 month after the therapy, pure-tone average was found to be 33.52 dB in the intratympanic steroid treatment group and 44.46 dB in the classic therapy group with a statistically significant intergroup difference. Gain was up to 34.76 dB in the intratympanic steroid treatment group whereas in the classic therapy group, the difference was 22.75 dB which was found to be statistically significant (p<0.05).

Conclusion: When treating idiopathic sudden hearing loss, intratympanic steroid treatment which was combined with sudden hearing loss treatment protocol tends to yield significant hearing gain when compared with the classic combined treatment.

Objective: To investigate how the various bilirubin levels on patients with neonatal unconjugated hyperbilirubinemia affect the hearing loss in early periods.

Methods: One hundred twenty one infants (89 with indirect hyperbilirubinemia and 32 healthy subjects) were included in the study. Seven working groups (Group I-VII) were formed in accordance with their bilirubin levels, which were 19.9 mg/dl and below, 20.0-29.9 mg/dl, 30 mg/dl and over, 10.95-38.08 mg/dl and premature, 20.01-38.08 mg/dl and with no exchange transfusion, 24.7-46.65 mg/dl and with exchange transfusion and control group, respectively. Each infant was controlled in terms of hearing tests including tympanogram, stapes reflex, otoacoustic emission at least 3 times within 12 months period. The auditory brainstem responses and free area behavioral threshold tests were performed on the cases which were found to have hearing loss by those tests.

Results: Stapes reflex could not be found on 1, 6, 3, 1, 4, 7 infants in the Groups of I-VI, respectively. Cochlear response in otoacoustic emission was not observed on 2, 8, 7, 2, 5, 11 infants, respectively. In the auditory brainstem responses, wave V was not found on 1, 4, 1, 1, 3, 2 infants, respectively. Free area behavioral threshold test performed on 6 patients whose auditory thresholds were thought to be low revealed normal threshold in 5 patients and extremely sensorineural hearing loss in 1 patient. No significant difference was observed among all working groups in terms of hearing loss.

Conclusion: In infants exposed to indirect hyperbilirubinemia (>20 mg/dl) for a long time, cochlear and auditory functions could be affected. Hearing loss, which is one of the probable complications of postnatal bilirubin encephalopathy, is required to be followed up closely for early diagnosis.