Volume 3 Issue 3 (2013)

Aural atresia is the congenital malformation of the ear characterized by partial or complete atresia of the external ear. Our aim is to show the effectiveness of the MET Fully-Implantable Ossicular Stimulator (FIMOS) Carina® in the treatment of hearing loss with auricular atresia. In this case, we experienced The MET Fully-Implantable Ossicular Stimulator (FIMOS) Carina® to the patient who has bilaterally congenital external ear canal atresia for rehabilitation of hearing loss. In postoperative sixth month audiological test the mean functional gain in a four frequency pure-tone average was approximately 39 dB HL. The capacity of the Carina® MET ossicular stimulator to provide appropriate gain relative to the degree of hearing loss indicates that the device may be a viable treatment for patients with agenesis of external auditory canal and severe malformation of the middle ear.

Gastroesophageal reflux disease is a common medical condition affecting approximately 35%-40% of the adult population in the Western world. Laryngopharyngeal reflux is an extraesophageal variant of gastroesophageal reflux disease that affects the larynx and pharynx. In recent years, many otolaryngologists have acknowledged the existence and potential importance of laryngopharyngeal reflux in patients with otolaryngologic complaints. The exact prevalance of laryngopharyngeal reflux is unknown. However, there is increasing evidence that gastroesophageal reflux disease may cause rhinological and laryngopharyngeal symptoms and at least 10% of all patients presenting to the otolaryngologists, have symptoms related to gastroesophageal reflux disease. Here we tried to summarize the mainlines of the larynopharyngeal reflux disease and diagnosis-treatment options up to date.

Objective: To analyze the ratio of paranasal sinusitis and mastoid air cell pathologies in patients presenting with complaints of headache in the Eastern Anatolia Region of Turkey.

Methods: A total of 2750 individuals presenting with complaints of headache and underwent cranial computed tomography and brain magnetic resonance imaging between 2006 and 2010 were included in the present study. Radiological examinations were analyzed for sinusitis and mastoditis.

Results: Mastoid air cells were found to be infected in 211 (7.7%) of 2750 cases included in the study, they were not infected in the remaining 2539 (92.3%) cases. Paranasal sinuses were not infected in 2516 (91.5%) cases and infected in 234 (8.5%) cases.

Conclusion: Contrary to the popular belief, considering sinusitis as the source of headache in a person presenting with such a complaint would not be the right thing to do. Presumed prevalence of sinusitis and mastoiditis in the Eastern Anatolia Region of Turkey is consistent with the data reported in the literature.

Objective: To present the results of 28 patients who were treated by Doppler ultrasound guided percutaneous ethanol injection (PEI) into benign cystic thyroid nodules.

Methods: Before percutaneous injection of ethanol, malignancies were excluded with fine needle aspiration biopsy. Volume of the nodule was calculated according to length χ width χ depth χ π/6 formula. During the application, 95% ethanol solution was injected about half of the initial cystic volume. At follow-up nodule diameter, formation of fibrosclerosis and nodule vascularization were evaluated. More than 50% reduction in nodule volume relative to the initial volume was defined success.

Results: The success rate with single application of PEI was found 88.5 percent. With administration of the second application of PEI on unsuccessful cases success rate increased to 92.9 percent.

Conclusion: Doppler ultrasound-guided PEI injection is a reliable, effective and inexpensive method in the treatment of thyroid cysts with high success rates.

Objective: Our aim was to evaluate factors affecting diagnostic value of the fine-needle aspiration biopsy (FNAB) used for the diagnosis of parotid tumors.

Methods: This study included 76 patients with available data who had been operated between 2005 and 2011 in Ankara Numune Training and Research Hospital. Impact of parameters which might affect the diagnostic value of preoperative FNAB results such as location, size, characteristics (cystic or solid) of the tumors, and use of ultrasonographic guidance (if any) were analyzed.

Results: Sensitivity (63%), specificity (98%), discriminative diagnostic value for benign (93%) and malignant (87.5%) tumors and tumor-specific diagnosis (42.1%) related to FNABs performed were also estimated. Ultrasound-guided FNAB increased adequacy of the material retrieved. A significant correlation has not been detected between diagnostic value of FNAB, location and size of the tumor.

Conclusion: FNAB appears to be a safe, cost-effective and minimally invasive method, which provides preoperative information for both the patient and the physician about parotid tumors with diagnostic accuracy over 90 percent.

Objective: To present combined technique (Mustardé and Furnas otoplasty) experience and to analyze the cosmetic results achieved and the incidence of complications and their management in otoplasty surgery.

Methods: A retrospective study was performed within the clinical databases for patients who had undergone combined Mustardé and Furnas otoplasty procedure. A total of 147 patients with protruding ears underwent otoplasty procedure from March 2008 and November 2012. Eighty-five of these 147 patients were operated with combined Mustardé and Furnas otoplasty procedure and met the eligibility criteria for the study. Data were tabulated and analyzed in regard to age, sex, method of otoplasty, side involved, and complications.

Results: Seventy-one patients underwent bilateral procedures and 14, unilateral, for a total of 156 ears reconstructed. One patient developed keloids treated with excision, and combination of topical and injected steroids. Suture extrusion, the most frequent but the most minor complication, was noted in eight ears. All extruded sutures were removed while the patient was under local anesthesia, and none of these patients required any additional procedures. Undercorrection was noted in seven ears which led to secondary correction.

Conclusion: The combined Mustardé and Furnas type otoplasty technique is a simple and safe procedure that does not cause anterior scarring or skin necrosis. In addition, the reconstructed ear shows reliable results in firmness and stability against external force or trauma.

Objective: We aimed to evaluate (laryngopharyngeal reflux) LPR disease group and group with healthy volunteers and compare results obtained using Dx pH probe in the diagnosis of LPR disease.

Methods: Fifty-seven LPR patients with typical scores of reflux symptom index (RSI) and reflux finding scoring (RFS) system and 20 healthy volunteers without laryngopharyngeal symptoms and physical examination findings were included in the study after excluding other concomitant diseases. All patients were requested to complete RSI and RFS forms. Healthy volunteers, with RSI 13 and RFS >7. Dx pH probes were applied to each group. Fisher’s exact test, Shapiro-Wilk test, T test and Mann-Whitney test were used for statistical analysis. A p value 0.05), despite a statistically significant intergroup difference (p<0.05).

Conclusion: Dx pH probe was found to be an alternative to other methods commonly used in the diagnosis of LPR. When compared with RSI and RFS scores, Dx pH probes provided consistent and accurate data. Dx pH probe application can be an alternative to frequently used diagnostic methods for LPR.

Objective: To determine whether specific allergens induce specific symptoms or not, and whether symptoms and the severity of the symptoms change in the parallel with the increase in the duration of allergic rhinitis or not.

Methods: This trial was conducted through retrospective screening of the data forms of patients who had presented to our ENT-Allergy Unit with allergic symptoms, and diagnosed as allergic rhinitis based on the history, examination and prick test or serum specific IgE results.

Results: A total of 235 patients were enrolled in the trial. Nasal discharge and postnasal drip were significantly less common in tree allergies, itching and watering of the eyes were more common in grass allergies. Redness in the eyes was significantly less common in weed allergies. Nasal discharge was significantly less common in allergy against animal epithelium and hair. Sneezing and itching/watering of the eyes were significantly less, while hyposmia was more frequently seen in house dust-mite allergies. Comparison of the duration of allergic rhinitis with the frequency of symptoms revealed a statistically significant increase in hyposmia and redness in the eyes in seasonal allergic rhinitis, parallel to the increase in the duration of allergic rhinitis.

Conclusion: We suggest that specific symptomatic treatments directed against the allergen(s) which also shorten duration of allergic rhinitis may be an option in the management of allergic rhinitis and will yield positive outcomes in terms of improved control of the symptoms and hence quality of life of the patients.

Objective: To investigate the importance of comorbidity, performance status, hemoglobin level, weight loss, interruption of radiotherapy, and mucositis as prognostic factors in head and neck cancer patients.

Methods: Two-hundred and ten patients who were admitted to the Oncology Center of our university between 2006 and 2012, and treated for head and neck cancer were included in the study. Performance status at admission was evaluated according to Eastern Cooperative Oncology Group (ECOG) scoring system. Staging of the disease was based on TNM staging system revised in 2010.

Results: The median follow-up period was 24 (range: 1-134) months. Recurrence was observed in 24% of the patients in a median 11 (range: 3-96) months. Metastasis was observed in 13% of patients, in the median 15 (range: 1-134 months). The 3-year local control, overall survival and disease-free survival rates were 72%, 59%, and 53%, respectively for all patients. The factors affecting the 3-year local control rates in univariate analysis were performance status (p=0.006), weight loss (p=0.002), localization (p=0.003), and stage (p<0.001) of the disease, and perineural invasion (p=0.011). The 3-year overall survival rates were not influenced by comorbidity (p=0.045), performance status (p<0.001), hemoglobin level (p<0.001), weight loss (p<0.001), perineural invasion (p=0.017), lymphovasculer invasion (p=0.022), localization (p=0.007), and stage of the disease (p<0.001), and interruption of radiotherapy (p=0.041). The prognostic factors for the 3-year disease-free survival were comorbidity (p=0.045), hemoglobin level (p<0.001), weight loss (p<0.001), perineural invasion (p=0.017), lymphovascular invasion (p=0.022), localization (p=0.007), and stage of the disease (p<0.001).

Conclusion: Weight loss and perineural invasion for local control; performance status, weight loss, hemoglobin level, and interruption of radiotherapy for overall survival; performance status, weight loss, and hemoglobin level for disease-free survival were found to be independent prognostic factors in multivariate analysis.

Objective: To evaluate the use of the Dacron® implant in laryngeal reconstruction and to discuss potential indications of this material in head and neck surgeries.

Methods: Three groups consisting of 12 Wistar albino rats in each were formed, Group 1 was the control group and anterior laryngotratecheal reconstruction was performed by transplanting autologous costal cartilage sized 5¥5¥5 mm obtained by 6 mm longitunal sectioning extending from cricoid cartilage to the 5th tracheal ring. Group 2: Trachea sectioning was performed in equal lengths as in Group 1, and anterior laryngotracheal reconstruction was carried out by transplanting the same sized homologous cartilage. Group 3: Trachea sectioning was performed in equal lengths as in Group 1 and anterior laryngotracheal reconstruction was carried out by Dacron® graft in the same size. The rats were sacrificed in the 12th week of the implantation, and the groups were compared in terms of their tracheal section area, partial oxygen pressure, epithelialization, neovascularization, inflammatory cell infiltration and new chondrocyte development.

Results: One experimental animal in Group 1 was lost due to pneumothorax on the second day postoperatively. In Group 3, one animal died because of development of granulation and crusting on the 8th day postoperatively. There was no statistically significant difference between the groups in terms of tracheal cross sectional area, and partial oxygen pressure. While there was no significant difference in terms of epithelial development and neovascularization between Groups 2 and 3, while Group 1 was significantly better than Groups 2 and 3. Lymphocytic infiltration is an essential parameter in graft rejection and there was a significant difference between the groups. Group 1 was better than the other two groups but it was determined that Group 3 was considerably different from Group 2. There was a significant difference between Groups 1 and 2 in terms of new chondrocyte development.

Conclusion: Autogenous costal cartilage is an ideal graft material for trachea and larynx since scores of epithelial development, neovascularization and chondrocyte development are better. Dacron® implant can be used safely in laryngeal reconstrucion as stenosis, infection and rejection did not occur in Group 3 exposed to Dacron®, and epithelial development and nerovascularization occurred satisfactorily in all experimental animals.