Volume 5 Issue 1 (2015)

Generally vocal fold polyps are small lesions causing dysphonia. In rare occurrences they may be huge in size and may present with dyspnea, choking spells, wheezing and stridor. We present five cases with giant vocal fold polyps with hoarseness and severe respiratory problems. In this report, clinical presentation and management of large vocal fold polyps are discussed.

Language and speech are natural tools for communication. Loss of hearing causes multiple problems, results in a decrease in life quality and psychosocial regression, depressive symptoms and communication failures. For situations when medical and/or surgical approaches to eliminate or reduce the effects of hearing loss do not succeed, hearing aid devices are an option. The aim of this paper is to determine the problems with usage of hearing aids by adults and to offer possible solutions. The selection of the type and model of a hearing aid device in a way to meet individual requirements is a critical step. An efficient hearing aid application is expected to be more beneficial when supported by an audiological rehabilitation. The problems encountered in usage of hearing devices in adult stage are not only physical factors but can also be individual factors. Lately the digital hearing devices are gaining popularity and utilisation problems are encountered quite less but still many problems are waiting to be solved. To minimise the problems encountered with usage of hearing aids in society, healthcare professionals advising hearing aids should have a better training and equipment, number of disciplines focusing on hearing devices should be increased and all related parties (government agencies, healthcare workers advising hearing aid devices, device suppliers) should follow developments in the field closely. It is expected for all the parties to find a common ground and aim for maximum benefit from the audiological rehabilitation of individuals with hearing loss.

Objective: Our aim was to investigate the prevalence and clinical features of allergic rhinitis in patients with ankylosing spondylitis.

Methods: This cross-sectional, clinical study was performed on 64 patients (24 females, 40 males) between October 2011 and November 2012. The Score for Allergic Rhinitis (SFAR) questionnaire was carried out to the patients with a recent diagnosis of ankylosing spondylitis. Skin prick test was performed to the cases who responded positively to SFAR. Descriptive parameters, clinical features and skin prick test results were documented.

Results: The mean age of the study group was 41.7±11.2. Eight patients (12.5%) were presumably diagnosed for allergic rhinitis according to SFAR questionnaire. Skin prick test yielded positivity for Dermatophagoides farinae and Dermatophagoides pteronyssinus in one of the 8 cases who responded positively for SFAR. The most common symptoms were sneezing (n=15; 23.4%), nasal obstruction (n=12; 18.8%), and nasal itching (n=12; 18.8%).

Conclusion: Our results demonstrate that prevalence of allergic rhinitis is lower in ankylosing spondylitis patients. However, clinical and pathophysiological features of allergic rhinitis accompanying autoimmune diseases must be investigated in further trials.

Objective: The objective of this study is to compare three different techniques applied during dacryocystorhinostomy in terms of recurrence and operative times.

Methods: Operative times and follow-up results of the patients who underwent endoscopic dacryocystorhinostomy surgery between January 2011 and April 2014 due to nasolacrimal duct occlusion were compared. Lacrimal sacs of the patients in Group 1 (n=15) were explored using gouge hammer and surrounding bony structures were dilated with diamond drilling instrument. Lacrimal sacs of the patients in Group 2 (n=11) were identified and dilated using Diamond drill. Lacrimal sacs of the patients in Group 3 (n=15), were found with the aid of a gouge hammer and enlarged using Smith-Kerrison punch forceps.

Results: There was no significant difference between Groups 1 and 2 as for recurrence rates. However, recurrence rates in Group 3 were found to be higher compared to Groups 1 and 2. Operative times demonstrated significant differences among 3 groups, with at its highest and lowest operative times detected in Groups 1 and 2, respectively.

Conclusion: With this study, it was concluded that exploration and identification of lacrimal sac using gouge hammer and expansion of the surrounding bony structure with diamond tipped drills during dacryocystorhinostomy is an improved method with relative shortness of the operative time and lower recurrence rates.

Objective: To evaluate the histopathological examination results, frequency of lesions and associated symptoms in patients with established unilateral nasal pathology.

Methods: Medical records of 73 patients with unilateral nasal lesions who undergone histopathological examination were analyzed retrospectively. Clinical presentation, examination and radiological findings, treatment and follow-up process of the patients were evaluated.

Results: Neoplastic (n=16) and non-neoplastic (n=57) pathologies were detected in 73 patients. Non-neoplastic lesions consisted of inflammatory polyps (n=16), chronic sinusitis (n=11), anthrocoanal polyps (n=6) which were the most striking unilateral nasal pathologies. Neoplastic group (n=16) comprised of 2 malignant and 14 benign cases which were classified as adenocarcinoma (n=1), adenoid cystic carcinoma (n=1), inverted papilloma (n=8), hemangioendothelioma (n=1), capillary hemangioma (n=1), fibrous dysplasia (n=1), osteoma (n=1) and pyogenic granuloma (n=2). The most frequently observed symptom was unilateral nasal obstruction. Especially in cases with neoplasms, the frequency of epistaxis increased significantly (p<0.05).

Conclusion: In cases with unilateral sinonasal symptoms, neoplasias should be kept in mind. A detailed anamnesis, attentive endoscopic examination and appropriate radiological imaging modalities in suspected cases and recurrent biopsies in case of need can reveal underlying pathologies.

Objective: Recent studies point to a relationship between allergic diseases and vitamin D deficiency. This relationship seems to be associated with immune-modulator effects of the derivatives of vitamin D. However, there are limited number of studies on the relationship between allergic rhinitis and derivatives of vitamin D. We planned our study to investigate this issue.

Methods: The study group was composed of 30 patients diagnosed with allergic rhinitis according to ARIA (Allergic Rhinitis and its Impact on Asthma) Criteria. The control group included 30 patients of the same age and gender without any allergic rhinitis disease. The patients with an underlying disease which may cause deficiency of calcium and vitamin D were excluded. The significance of the difference between study and control groups in terms of serum 25-hydroxy (OH) vitamin D levels was also evaluated.

Results: It was determined that the levels of vitamin D were within normal (10–90 ng/mL) limits in both groups. It was found out that the mean serum 25(OH)vitamin D level (15.39 ng/mL) of the study group was significantly lower than the control group (53.80 ng/mL) (p=0.00). No significant difference was found between the genders in terms of vitamin D levels (p=0.398).

Conclusion: It is necessary to do more researches on the effects of vitamin D derivatives on allergic rhinitis. This study indicates that a vitamin D deficiency should be taken into consideration during the treatment for resistant allergic rhinitis patients.

Objective: To investigate whether the choice of a hypovascular or a hypervascular site of a thyroid nodule affects the efficacy of the ultrasound-guided fine needle aspiration procedure or not.

Methods: Sixty solid thyroid nodules in 60 patients with hypo- and hypervascular parts were included in this prospective clinical study. Under color Doppler sonographic guidance, the fine needle aspiration was made with 22-gauge needle. Radiological and cytological features as well as the adequacy of samples were noted and compared.

Results: Sonographically, 25 nodules (41.7%) were hetereogenous and calcified, 21 were hypoechoic (35%), 10 were isoechoic (16.7%) and 4 were hyperechoic (6.6%). Rate of adequate sampling when only hypervascular was used or hypovascular sites were evaluated were 81.7% and 83.3%, respectively. When both sites were evaluated together, rate of adequate sampling was found to be 91.7% in total. Presence and distribution of endothelial cells in the sample seems not to influence the diagnostic value of the procedure.

Conclusion: Our results indicate that vascularity of a thyroid nodule outlined by color Doppler sonography can aid in optimizing the efficiency of fine-needle aspiration biopsy. The samples obtained from aspirates of hypo- and hypervascular sites are both complementary and assessment of these sites together yields better results in terms of diagnostic accuracy.

Objective: The aim of this study was to evaluate the different factors that may affect graft success in tympanoplasty with mastoidectomy.

Methods: Patients who underwent tympanoplasty with mastoidectomy between September 2004 and July 2010 were included in this study. Patient data were collected retrospectively. The effects of the epitympanic patency, duration of the dry period of the ear, presence of preoperative otorrhea, location of the perforation, status of the middle ear mucosa, and status of the tympanic membrane on the rate of postoperative graft success in patients who underwent tympanoplasty with mastoidectomy were investigated. The chi-square test and Fisher’s exact test were used for statistical analysis.

Results: A total of 130 patients, 74 male and 56 female, with an average age of 35.7 (range: 11 to 56) years were included. The overall success rate for full postoperative graft success was 75%. A >3-month dry period of the ear, absence of preoperative otorrhea, preoperative normal middle ear mucosa, and presence of epitympanic patency significantly increased the postoperative success rate of graft (p<0.001). The presence of preoperative otorrhea and granulation tissue in the middle ear mucosa, presence of preoperative myringosclerosis, and lack of epitympanic patency were significantly associated with graft failure after tympanoplasty with mastoidectomy (p<0.001).

Conclusion: Epitympanic patency, middle ear infection, morphologic features of the tympanic membrane and middle ear mucosa are likely to affect graft success in tympanoplasty with mastoidectomy.

Objective: The aim of this study was to outline the histopathological findings of nasal polyposis and to investigate whether these findings were associated with the severity of the disease and co-existing morbidities as well as hematological parameters.

Methods: Seventy-seven nasal polyposis (52 male, 25 female; mean age: 46.99±13.27 years) patients who underwent endoscopic sinus surgery between 2007 and 2011 were included in the study. Data was extracted from medical files and endoscopy scores, and Lund-Mackay Computed Tomography scores, Nasal Obstruction Symptom Evaluation (NOSE) scales, presence of allergy and asthma, and blood eosinophil levels were noted. Correlation of this data with histopathological findings (such as basement membrane thickness, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophilic infiltration, lymphocytic infiltration and polymorphonuclear leukocyte infiltration) was analyzed.

Results: Analysis of our findings yielded that the only statistically significant finding was the correlation of eosinophilic infiltration with the blood eosinophil level (p<0.01). No other statistically significant differences were found between histopathological findings and accompanying clinical or hematological parameters under investigation.

Conclusion: Results of the current study have shown that histopathological features of nasal polyposis do not exhibit correlation with the severity or extent of the disease.