Volume 4 Issue 2 (2014)

Objective: To evaluate the clinical signs and symptoms, diagnosis, treatments, outcomes, distribution and incidence of the complications of chronic otitis media (COM).

Methods: This retrospective study analyzed the clinical and operative findings of 1293 patients with COM, including 39 patients with complications of COM. We compared the surgical techniques, incidence and management of complications and morbidity and mortality rates with those reported in the relevant literature.

Results: Of the patients with complications, 23 were male and 16 were female. Eight patients (20.5%) had intracranial complications, while 31 (79.5%) had extracranial complications. Lateral sinus thrombophlebitis and labyrinthine fistula were the most common intra- and extracranial complication, respectively. Of the 39 patients with complications, 27 underwent radical mastoidectomy, including two patients who underwent simultaneous labyrinthectomy. Revision radical mastoidectomy, canal wall down tympanomastoidectomy and canal wall up tympanomastoidectomy were performed in one, six and five patients, respectively. All patients did well, and the mortality rate was 0% during a follow-up period of 46±22 months.

Conclusion: Despite their reduced incidence, COM complications continue to pose a great, clinical challenge. A careful history, physical examination, effective use of imaging technology and most importantly, a greater awareness of COM complications will reduce their morbidity and mortality.

Objective: To determine whether there is any radiologically detected effect of allergic rhinitis on nasal septal body (NSB) size.

Methods: Forty patients previously diagnosed with allergic rhinitis, and randomly selected thirty controls without allergic rhinitis were included in this study. Measurements of NSB size were performed in coronal plane paranasal sinus CT. Patients who had undergone nasal surgery, those with nasal polyposis, patients still using topical nasal spray, oral antihistamines, oral steroids and oral leukotrienes were excluded from the study.

Results: The average width of NSB was found 11.2 mm in patients with allergic rhinitis and 10.74 mm in patients without allergic. There was no significant difference between patients with and without allergic rhinitis in terms of NSB size on coronal plane paranasal sinus CT examination.

Conclusion: Our results did not support the findings of previous studies. However, further randomized, prospective, controlled trials on larger series are necessary for making more precise interpretations.

Objective: In the present study, thresholds of airway tone-burst auditory brainstem response (ABR), and pure-tone audiometry were compared, and correlations between threshold values obtained with classical audiometric methods, and pure-tone airway hearing in individuals with advanced, and very advanced sensorineural (S/N) hearing loss were investigated.

Methods: Eighty patients with advanced and very advanced S/N hearing loss were included in the study. Pure-tone air conduction thresholds of advanced, and very advanced S/N hearing loss patients detected at 500, 2000 and 4000 Hz frequencies were compared with tone-burst ABR threshold values.

Results: Our study population consisted of males with a mean age of 21.8±3.45. Mean differences between thresholds of tone-burst, and pure-tone audiometry were detected to be 4.75 dB, 6.25 dB, and 4.87 dB at stimulus frequencies of 500 Hz, 2000 Hz, and 4000 Hz, respectively.

Conclusion: In conclusion, in patients with S/N hearing loss, a strong correlation is found between pure-tone audiometry thresholds, and electrophysiological thresholds obtained at 500, 2000, and 4000 Hz with tone-evoked ABR wave-V. Tone-ABR can be used as a reliable test in the diagnosis of patients with hearing loss in conditions where pure-audiometry cannot be performed.

Objective: We aimed to compare the use of Merocel nasal packs and airway integrated silicone nasal septal splints in the management of postoperative complications such as synechia formation, septal perforation, recurrent deviation and to evaluate nasal obstruction by using Nose Obstruction Symptom Evaluation scale following septoplasty.

Methods: Ninety-six patients who complained of nasal obstruction and underwent septoplasty under general anesthesia were enrolled in the study. The patients were randomly allocated into two groups as Group A (Merocel group) and Group B (silicone splint group). A follow-up visit was scheduled two months after surgical procedure and four different variables were investigated: (1) recurrent deviation (2) synechia (3) septal perforation; and (4) Nose Obstruction Symptom Evaluation scale score.

Results: We found more frequent postoperative complications in the Merocel group but this finding was not statistically significant (p>0.05). Additionally comparison of Nose Obstruction Symptom Evaluation scale scores for nasal packing materials did not detect statistically significant difference between 2 groups (p>0.05). Interestingly, we identified that in a subset of patients who had synechia formation, Nose Obstruction Symptom Evaluation scale scores had been significantly higher in comparison with the patients without synechia formation (p<0.05).

Conclusion: Although our data did not reach statistical significance, our study and previous reports support a better quality of life by using intranasal splints, but that needs further studies.

Objective: To investigate the correlation of inflammatory process, endothelial dysfunction and oxidative stress with obstructive sleep apnea (OSA).

Methods: In our prospective cross-sectional clinical study in a tertiary referral hospital, we evaluated 63 patients with newly diagnosed OSA and 9 simple snorers. Each patient was evaluated in terms of additional systemic diseases and laboratory tests. In addition to routine blood analysis; oxidative stress markers (leptine, RBP), vascular endothelial markers (ICAM-I, VCAM-I) and inflammatory markers (Crp, IL-6, TNF-alpha, isoprostane) were analyzed. Polysomnography test was performed and study population was divided into four groups depending on their AHI values. The levels of markers were analyzed and compared between the four groups.

Results: There was a weak correlation between the isoprostane levels and mean apnea duration and also a mild correlation to the maximum apnea duration. A weak correlation was detected between leptine and VCAM levels to age and also a weak negative correlation was detected between CRP levels to age. The leptin levels were found to be mildly correlated to BMI and abdominal circumference. The ICAM levels were found to have a weak correlation to BMI and abdominal circumference.

Conclusion: Our results indicate a correlation between sleep apnea and oxidative stress. These results may help to explain the association of co-morbid diseases with OSAS. Further investigators should aim to explain key steps of inflammatory response in sleep apnea.

Objective: The impact of fascia lata on neochondrogenesis placed between both leaflets of the perichondrium after full thickness submucoperichondrial cartilage resection was investigated in a rabbit septum model.

Methods: Twenty adult New Zealand rabbits were studied in two groups with equal number of animals in each group. Full thickness cartilage with an area of 1 cm2 was resected to create a cartilage defect in all rabbits. Autogenous fascia lata was interposed between both leaflets of the perichondrium and the surgical field was closed (fascia lata group). No material was interposed between both leaflets of the perichondrium of the defective area (control group). Rabbits were sacrificed on postoperative 90th days and their septa were totally excised. Neochondrogenesis was investigated histopathologically with a light microscope. The preparations were evaluated as for thickness of newly formed cartilage (in mm), inflammatory reaction and presence of macroscopic perforation.

Results: Thickness of the cartilage in the fascia lata group was significantly greater than that of the control group (M-W-U=15,000, p<0.05).

Conclusion: Use of fascia lata in the acceleration of perichondrial neochondrogenesis can result in successful outcomes in the repair of cartilage defects.

Thyroid carcinomas reported to metastasize to scalp were reviewed and discussed with histopathological, prognostic and diagnostic aspects. All cases of scalp metastasis from thyroid carcinomas published in PubMed and MedLine were reviewed and the data of all patients were analyzed to obtain information about the patient demographics, histologic type of thyroid carcinoma, additional cutaneous sites, time interval between the diagnosis of the primary tumor and the diagnosis of scalp metastasis. The literature review revealed 38 cases of scalp metastasis from thyroid carcinoma. The most common histologic type was follicular carcinoma (46%), followed by papillary (35%), medullary (16%) and anaplastic carcinomas (3%). Scalp as a distinct cutaneous area has a rich dermal vasculature and is a site of various primary and metastatic neoplasms. Metastases to scalp from thyroid carcinomas are extremely rare and demonstrate advanced disease and poor prognosis. A scalp nodule may be a diagnostic challenge if it is the presenting symptom of an occult neoplasm with low metastatic potential. Awareness of the histopathological characteristics, and cutaneous metastatic patterns of thyroid carcinomas can help us to overcome the difficulty in diagnosis of such lesions.

Schwannomas are benign, encapsulated and slowly growing neoplasms arising from schwann cells of the sheath of the peripheral nerves. In the head and neck region, schwannomas are often encountered as acoustic neuromas. A nasal septal mass in a 65-year-old male patient was resected en-bloc which was reported to be a schwannoma. No recurrence was observed in the fourth postoperative year. In conclusion, although rarely encountered, nasal septal schwannoma should be considered in the differential diagnosis of nasal masses. Even though total excision of the mass will be sufficient for the prevention of recurrence, the tumor should be sent to pathology for a definite histopathological diagnosis. Since malignant transformation has been reported, long-term follow-up is mandatory.

Head and neck cancers are the sixth most common type of cancer in world; and of these, less than 10% are oropharyngeal cancers. The most common malignant tumor of oropharynx, even though it is accepted as a part of digestive system, is squamous cell carcinoma. On the other hand, adenocarcinoma, a common histopathological type for digestive system, is very rarely reported at base of tongue. Therefore, this article was aimed to present a 72-year-old male patient with a primary adenocarcinoma of the base of tongue and discuss the clinical presentation, radiological evaluation, histopathological examination, treatment modalities and prognosis with the literature.

The authors of the above article discovered a significant inaccuracy in their own paper that has been published in J Med Updates 2014;4:16-19. They retract this publication due to mispresentation of the data of the study.