Volume 6 Issue 1 (2016)

Objective: We assessed the association between the polymorphisms and expressions of three cytokine genes and clinical parameters in children who underwent cochlear implantation due to profound congenital sensorineural hearing loss.

Methods: We analyzed the IL-6/-174, IFN-γ/+874 and TNF-α/- 308 genes in 64 cases with congenital sensorineural hearing loss and in 70 healthy controls. Cytokine genotyping/expression was performed using the PCR-SSP method.

Results: No significant differences were detected between the patient group and the healthy controls with respect to the distributions and numbers of genotypes and alleles of TNF-α or IL-6. However, the TT genotype, associated with high expression of IFN-γ, and the T allele frequency were significantly more frequent in the patient group versus the controls (p=0.016 and 0.023, respectively).

Conclusion: Our results suggest that high expression of the IFN-γ gene may be associated with susceptibility to the disease. Consequently, IFN-γ may be a useful marker of the etiopathogenesis of congenital sensorineural hearing loss.

Objective: In laryngeal cancer the most suspected regions of invasion are preepiglottic space (PES), anterior commissure (AC), thyroid cartilage (TC), subglottic region (SR) and extralaryngeal spread (ELS). The objective of this study is to compare the results of preoperative computed tomography (CT) with postoperative histopathologic analysis in these critical regions for the total or partial laryngectomy.

Methods: Eighty-nine patients, who had undergone total laryngectomy with a diagnosis of laryngeal cancer reported that squamous cell cancer (SCC) between 2005 and 2013, were reviewed retrospectively. All the patients, after the first application done total laryngectomy before flexible laryngoscopy, computed tomography for the neck and endoscopic biopsy with direct laryngoscopy. Histopathological results of PES, AC, TC, ELS and SR invasion are compared to preoperative CT findings and determined of specificity, sensitivity, false negative and false positive results and rate of accuracy.

Results: All the patients were male, median age was 67 (range: 48 to 81) years. Fifty-six patients were in T4 and 33 patients in T3 stage. Compared to results between positive CT findings and negative histopathological examination; PES invasion in 41 patients/ 5 patients, AC invasion was found in 38/ 15 patients, TC invasion in 28/16 patients, SR invasion in 49/ 9 patients and ELS invasion in 25 /7 patients. Accuracy rate of computed tomography in these regions are 85%, 64%, 76%, 79%, and 83%, respectively. All the results especially thyroid cartilage invasion were statistically significant.

Conclusion: In all regions invasion, CT has a low diagnostic reliability in high-grade laryngeal cancer in our study. We suggested that histopathological results are the gold standard intraoperatively for determining total or partial laryngectomy.

Objective: Inflammation has an important place in chronic otitis media with effusion (COME) etiology. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are simple and cheap tests that show inflammation and can be calculated by all physicians. In our study, we aimed to investigate the relationship between COME and NLR and PLR parameters.

Methods: The study was performed with the pediatric patient group consisting of 77 patients who got diagnosis of COME and the control group consisting of 62 healthy children whose age, gender and demographical characteristics were concordant with the patient group. The patient and control groups were compared statistically in terms of NLR and PLR values.

Results: Mean neutrophil to lymphocyte ratio value was found as 1.43±0.54 in the patient group and as 1.16±0.51 in the control group (p<0.001). Mean PLR value was found as 113.78±35.78 in the patient group and as 103.61±32.32 in the control group (p= 0.084).

Conclusion: Neutrophil to lymphocyte ratio and PLR values were high in COME. It was shown for the first time that NLR can be used as a diagnostic parameter in children with COME.

Objective: The aim of the present study was to determine correlations between CT90 and CT95 values and physical examination parameters, chronic metabolic diseases, smoking, mean platelet volume, cerebral magnetic resonance imaging (MRI), presence and number of hyperintense foci in obstructive sleep apnea (OSA).

Methods: A total of 1154 patients who underwent polysomnography in our sleep laboratory between 2011 and 2014 were screened retrospectively. Among them, 72 cases who underwent ear, nose and throat examinations, cerebral MR, CBC and biochemical tests were included in the study. All patients underwent a detailed anamnesis together with (1) measurements of BMI (body mass index) (2) circumferences of neck and abdomen, (3) examination of oropharynx, (4) Müller maneuver with the aid of fiberoptic endoscope, (5) estimation of Epworth sleep scale scores, (6) and polysomnographic (PSG) tests.

Results: According to the severity of OSA, the patients had simple snoring (22.2%), mild (19.4%) and severe OSA (38.9%). In multivariate regression analysis, body mass index (BMI) (p=0.026) and apnea/hypopnea index (AHI) (p=0.013) were seen as independent variables affecting CT90 (R2=49%). Multivariate linear regression analysis demonstrated that independent variables of smoking (p=0.001), AHI (p= 0.003) and number of hyperintense foci (p=0.013) affected CT95 (R2=%47.9), while relationships between diabetes, BMI and CT95 were not statistically significant.

Conclusion: Since CT95 values are affected by smoking without any statistically significant correlation with retropalatal and retroglossal Müller stages, we think that consideration of CT90 value will be more appropriate in the evaluation of the severity of chronic intermittent hypoxia in patients with obstructive sleep apnea. However, the correlation between CT90 value and AHI is closer to the value indicated in the literature, but not stronger.

Objective: The purpose of this case control study is to establish the influence of iris color and retina pigment epithelium melanin on allergic rhinitis.

Methods: Ninety-nine subjects diagnosed prospectively as allergic rhinitis and 85 control subjects were included in the study. Color of iris was recorded after ophthalmic examination. Electro-oculographic measurement was done after pupil dilatation and Arden ratios were recorded.

Results: Mean age was 29.44±9.8 years in subject with allergic rhinitis and 32.67±12.9 years in control subjects (p>0.05). Measured mean Arden ratio was 158.22±29.4 in subjects with allergic rhinitis and 179.34±29.3 in normal subjects (p<0.05). In control group, Arden ratio was significantly higher in eyes with brown iris (p<0.05). In subjects with allergic rhinitis, Arden ratio was significantly lower in brown eyes (p<0.05).

Conclusion: An association between allergic rhinitis and melanin content of iris and retina pigment epithelium was found. It can be speculated that pigment-producing system may play a role in the pathogenesis of the allergic rhinitis.

Objective: To evaluate the long-term findings obtained using microscopic approaches to attic cholesteatoma and with respect to the reconstruction materials used in ossiculoplasty.

Methods: The results of these procedures were evaluated in 30 of the patients who subsequently returned for follow-up. One of the surgical techniques among atticotomy + tympanoplasty, intact canal wall tympanoplasty (ICWT) and canal wall-down tympanomastoidectomy (CWDT) was performed. The responses to procedures based on postoperative complaints, otoscopy and audiometry results were evaluated and compared with those pre-treatment.

Results: A comparison of the preoperative and postoperative air-bone differences in 26 (85%) patients showed a hearing gain of 5–35 dB. The largest gain was achieved with ICWT type II surgery. Evaluation of the tympanic membrane by microscopic otoscopy showed various degrees of retraction in 30% of the patients in the open group and approximately 20% of those in the closed group. After a six-year long-term followup, 55% of the patients in the open group and 45% of those in the closed group had normal findings.

Conclusion: An adequate exposure allowing full removal of an attic cholesteatoma may require an open technique. Compared to closed techniques, this also allows hearing preservation and ossicular reconstruction. Good results in the reconstruction of the ossicles can be achieved using recently developed biomaterials, assuming that the stapes and manubrium mallei are in good condition.

Objective: In this study, we aimed to evaluate the isolated strains from the patients with chronic dacryocystitis and the relationship between different anatomical areas and their antibiotic susceptibilities.

Methods: Fifty patients diagnosed with chronic dacryocystitis were included. Fifty patients underwent endoscopic endonasal dacryocystorhinostomy from March 2013 to April 2014. Swab samples were obtained from conjunctiva and inferior nasal meatus before surgery, obtained from lacrimal sac during surgery. Identification and antibiotic susceptibility of the isolated strains were performed by automated Vitek version 2.0 systems (BioMeriuex Inc., Marcy-l'Étoile, France).

Results: A total of 39 (78%) female and 11 (22%) male patients were operated and 150 swab samples were evaluated. Bacterial growth was detected in 136 (90.6%) culture samples. A single (n=125; 91.9%) or two different (n=11; 9.1%) microorganisms were grown on culture media. The distribution of gram-positive strains (n=91) and gram-negative strains (n=56) were 61.90% and (38.10%), respectively. The most frequently isolated gram-positive isolate was Staphylococcus. Gram-negative isolates were susceptible to third-generation cephalosporins, cefepime and carbapenems while gram-positive isolates were susceptible to vancomycin, teicoplanin and linezolide.

Conclusion: For methicillin-sensitive coagulase-negative Staphylococci and methicillin-resistance coagulase-negative Staphylococci, bacterial growth demonstrated similarities among three different compartments (conjunctiva, lacrimal sac and inferior meatus). In other words, growth of these microorganisms in one location points to their proliferation in the other location or vice versa. This data can be used to guide antimicrobial therapy for these cases; but further studies are required.

Objective: The objective of the study is to determine the incidence of occult lymph node metastasis detected in patients with head and neck cancer who applied to our clinic.

Methods: Medical files of 107 patients who had been diagnosed as head and neck cancer between 2007 and 2012 were retrospectively examined. The patients who were accepted as N0 both clinically and radiologically at the time of diagnosis and those who had undergone neck dissection in addition to the treatment of primary tumor were included in the study. The patients were grouped based on the diagnosis of the primary tumor. Histopathology results of the patients and those with lymph node metastasis were documented. The proportion of the patients with occult lymph node metastases was calculated and primary tumor sites with a higher probability of occult lymph node metastases were determined.

Results: A total of 64 patients were included in the study who were diagnosed as laryngeal (n=42; 65.6%), oral cavity (n=15; 23.4%), parotid gland (n=5; 7.8%), nasal cavity (n=1; 1.5%) and auricular (n=1; 1.5%) carcinomas. Histopathologically lymph node metastases were detected in patients with laryngeal (n=12; 70.5%), oral cavity (n=4; 23.5%) and parotid gland (n=1; 5.8%) carcinomas. Laryngeal cancers were subdivided into supraglottic (n=4), transglottic (n=7) and glottic (n=1) cancers. The highest rate of metastasis was detected in patients with transglottic laryngeal carcinoma.

Conclusion: Occult lymph node metastasis is an important issue which should be kept in mind in cases with head and neck cancers. Location of primary tumor is an effective influential factor concerning this issue. As a result of this study, we thought that occult lymph node metastases are frequently seen in patients with transglottic laryngeal cancers.

Effervescence is defined as the evolution of gas bubbles from a liquid as a result of a chemical reaction. For medicinal use, effervescent tablets have specific characteristics that allow rapid adsorption of the intended drug. In this manner, a medication can be absorbed easily and effectively if it dissolves easily in water and is present at a sufficient dose. Common acids utilized for effervescent reactions are citric, malic, tartaric, adipic and fumaric acids. Citric acid is most commonly used for this application, which also adds a citrus-like taste to the products. Tartaric, adipic and fumaric acids are usually used in small amounts, due to their low water solubility. Effervescent tablets are used to simplify the handling of doses, provide optimal compatibility, promote superior and rapid absorption, increase a patient’s liquid intake and circumvent the difficulty of swallowing large pills. This review defines effervescent tablets in terms of the technology and describes the advantages and disadvantages.

Follow-up and treatment of multiple lesions in intensive care units are arranged within the discipline of approach to a case of injury. Herein, we present a 38-year-old female patient who had head trauma caused by a fall from a minibus. The patient was presented to our intensive care unit with epidural hematoma; however, tracheal rupture was found during the follow-up. Tracheal injuries and especially ruptures are not frequently encountered events even in cases with severe traumas. In traumatic events, it is difficult to diagnose tracheal rupture because of serious problems related with many organ systems. After establishment of diagnosis, it is possible to encounter relevant neurological and infectious problems because of longer treatment process. As in the case with our patient, in patients without any additional previously experienced respiratory problems while intubated development of respiratory distress hours after recurrent periods of intubation and extubation should suggest the presence of tracheal rupture.

The authors of the above article discovered a significant inaccuracy in their own paper that has been published in ENT Updates 2015;5(2):72-75. They retract this publication due to duplicate publication of the same material in another issue of the same journal by mistake.