Volume 4 Issue 3 (2014)

A 49-year-old woman admitted to our clinic due to a progressive hoarse voice for 4 years, foreign body sensation in the back of her throat, otalgia, hoarseness and mouth breathing. Nasolaryngoscopy demonstrated a right nasopharyngeal mass extending to oropharynx. Indirect laryngoscopy revealed a granulomatous lesion originating from right band ventricle and extending on the right vocal fold. The granulomatous lesion did not alter correct laryngeal mobility. There was no history of difficulty in swallowing. A contrast enhanced computed tomography showed a smooth mass involving nasopharynx and glottis. A direct laryngoscopy was planned for excisional biopsy of the lesion. Histopathological examination revealed nasopharyngeal and laryngeal amyloidosis. Further evaluations were negative for systemic amyloidosis. The aim of the report is to present an extremely rare case of isolated primary nasopharyngeal and laryngeal amyloidosis and discuss by using current literature knowledge.

In this review paper, we reported otolaryngological problems in patients with mucopolysaccharidoses (MPSs). Mucopolysaccharidoses are a group of lysosomal storage diseases, each of which is produced by an inherited deficiency of an enzyme involved in the degradation of acid mucopolysaccharides, now called glycosaminoglycans (GAGs). The mucopolysaccharidoses consist of a group of 7 metabolic disorders, known as mucopolysaccharidoses types I–VII. In all groups, there are clinical and otolaryngological manifestations. In MPS patients, upper airway obstruction, obstructive sleep apnea, restriction of mouth opening, middle ear effusion, hearing and breathing problems, etc. are reported as common otolaryngological findings. Increasing awareness of MPS’s among ENT doctors will be a life saving attempt for MPS suspected patients who admit an ENT doctor rather than a pediatrician. In MPS patients, tracheotomy may be difficult due to short neck. Due to mouth opening restriction, patients should be evaluated carefully before tonsillectomy and adenoidectomy operations. Airway problems must be evaluated before anesthesia. All ENT doctors should be noticed to be aware of these problems.

Objective: In this study, our aim was to evaluate statistically demographic distribution, presenting complaints, requested examinations, prescribed drugs, and follow-up recommendations related to the patients who applied to the otorhinolaryngology outpatient clinics in a rural area of Turkey.

Methods: Examinations, and treatments applied by three physicians on separate days, and at different times of the day in outpatient clinics were recorded.

Results: When the complaints of the patients were analyzed, upper respiratory tract infections were observed as the most frequent causes of hospital referrals. It has been indicated that any tests had not been required from majority of the patients, and if required, most of them were audiological tests. Prescriptions were written for the treatment of upper respiratory tract infections, and follow-up visits were not recommended for half of the patients.

Conclusion: As deduced from this study, primary, and secondary health care services provide 1/3, and 2/3 of otorhinolaryngology services in the rural areas of Turkey.

Objective: To report our experience about pedicled pectoralis major myocutaneous flap (PMMF) for the treatment of pharyngocutaneous fistula (PCF).

Methods: Between June 2006 and September 2014, 202 consecutive total laryngectomies for laryngeal or hypopharyngeal squamous cell carcinoma were performed in our hospital. The medical records of the patients were retrospectively reviewed to document the development of a PCF.

Results: PCF developed in 45 of 202 patients (22%) in the study group. Of these 45 patients, spontaneous closure with local wound care was achieved in 33 patients (73%). Remaining 12 patients required surgical closure with PMMF. Four of 12 patients (25%) had complications after surgical closure with PMMF. Radiotherapy had been performed before laryngectomy in 16 of 45 patients with PCF. Of these 16 patients who developed PCF and have had previous radiotherapy, spontaneous closure with local wound care was achieved in four cases, while PMMF was used in the remaining 12 cases.

Conclusion: Pedicled pectoralis major myocutaneous flap is a good reconstructive option in the treatment of PCF formation following total laryngectomy surgery.

Objective: We retrospectively analysed clinical characteristics, treatment and outcomes of the patients with Ramsay Hunt syndrome.

Methods: Twelve patients with Ramsay Hunt syndrome were analysed retrospectively. Data recorded included sex, age, time from first onset to initial treatment and clinical outcomes. The House-Brackmann scale was used to assess initial facial nerve dysfunction and final facial nerve impairment. All patients were treated with oral steroids and oral acyclovir.

Results: There were 7 male and 5 female patients. Mean age was 59 (range: 21 to 68) years. The main symptom was acute facial palsy. House-Brackmann classification of facial nerve function ranged from grade III to VI before treatment. The median baseline House-Brackmann grade was 4.5 and it was 2.33 after the treatment in all patients. Recovery rate of facial palsy was lower in patients with House-Brackmann grades V and VI.

Conclusion: In this syndrome, the prognosis of facial palsy depends on the initial symptoms and clinical findings. The prognosis was poorer in severe palsy and patients with comorbid disease(s).

Objective: To investigate hearing loss ratio of babies screened at our university hospital which is reference hospital in Kütahya, Turkey

Methods: A total number of 6881 newborns were screened for hearing between February 2010 and December 2013 in our hospital. Screening was done before newborns discharged. The parents of the newborns discharged during holidays were asked to come within 15 days. A three-stage screening protocol was implemented consisting of an initial screening with transient evoked otoacoustic emissions (TEOAE) followed by a second-stage screening also with TEOAE and screening auditory brainstem response (ABR). Babies who had unilateral or bilateral referrals with TEOAE and screening ABR were referred to other clinics which have clinical ABR. Babies were divided into 2 groups by means of having risk factors and not having risk factors.

Results: Out of 6881 newborns, 33 (0.47%) of them had hearing loss consisting of 21 (0.3%) patients had bilateral hearing loss and 12 (0.17%) patients had unilateral hearing loss.

Conclusion: Newborn hearing screening tests should be done throughout the country and the babies with hearing loss should be identified before permanent damages occur so that these patients can be productive people for society.

Objective: To evaluate the relationship between paradoxical vocal cord motion (PVCM) disease and the diseases such as asthma, laryngopharyngeal reflux and anxiety disorder that should be taken into consideration most frequently in differential diagnosis.

Methods: The study included 100 patients (64 females and 36 males) who had applied to the polyclinics of pulmonary diseases, gastroenterology, psychiatry and ear nose throat due to respiratory symptoms. In asymptomatic period, it was planned to diagnose paradoxical vocal cord motion due to inspiratory adduction and posterior glottic fissure observed in videolaryngoscopic examination made after provocative maneuvers.

Results: The mean age of the patients was 44.7±7.3 (female: 36.3±4.5, male: 52.3±3.2). 57% of the patients applied to pulmonary diseases, 24% to gastroenterology, 12% to psychiatry and 7% to ENT polyclinics. No paradoxical vocal cord motion was detected in 99 patients invideolaryngoscopic examination made after provocative maneuvers performed in asymptomatic period. Paradoxical vocal cord motion was detected in one patient who had attack during videolaryngoscopic examination.

Conclusion: Although PVCM is a rarely seen disease, it leads to serious problems in non-diagnosed patients. In our study, we concluded that PVCM can be diagnosed during an attack rather than provocativemaneuvers performed during asymptomatic period.

Objective: To evaluate success of tympanoplasty type 1 in the treatment of patients with sclerotic mastoid bone.

Methods: A retrospective study where 92 patients with non-cholesteatomatous chronic suppurative otitis media were recruited during the period of 2010 to 2012. Patients were managed medically and after dryness of their perforations they were operated upon. Ninety-two patients underwent type 1 tympanoplasty alone without cortical mastoidectomy. Underlay technique with chondroperichondrial graft was performed for all patients.

Results: Mean air-bone gap values were estimated and compared. In pre- and postoperative audiograms, air-bone gap values at 500, 1000, 2000 and 4000 Hz frequencies were determined. Pre- and postoperative mean air-bone gap values of the patients were 23.47±4.95 and 11.58±4.77 dB, respectively.

Conclusion: Our study emphasizes the fact that overall satisfactory hearing outcome with adequate air-bone closure can be achieved irrespective of cortical mastoidectomy in the surgical treatment of noncomplicated chronic ear diseases.

Objective: Dacryocystorhinostomy (DCR), the treatment for nasolacrimal duct obstruction, is generally performed endonasally. In this retrospective study, we compared the anatomical and functional success rate of endonasal DCR with endocanalicular diode laser DCR.

Methods: Medical records of 53 patients in endonasal DCR group (Group 1) and 47 in endocanalicular diode laser DCR group (Group 2) were analyzed for preoperative syringing and probing evaluations as well as surgical details, outcomes and complications.

Results: Recurrence was observed in eight patients in Group 1 and six in Group 2. Although the recurrence rates differed between the two groups, this difference was not statistically significant (p>0.05). The complications in Group 1 included eight cases of synechia and one tube protrusion, whereas the complications in Group 2 included two cases of synechia, two tube protrusions and two punctum atrophies. The presence of allergy, concha hypertrophy and septum deviation did not significantly increase the rates of recurrence or complications (p>0.05). Bleeding and pain were observed significantly more frequently in Group 1 and the patient comfort was significantly better in Group 2 (p<0.05).

Conclusion: Endocanalicular diode laser DCR was found to be a good alternative to endonasal DCR surgery thanks to better postoperative comfort, shorter healing time and less postoperative pain.