Volume 8 Issue 1 (2018)

Objective: To determine the quantitative values of apparent diffusion coefficient (ADC), standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), metabolic tumor volume indexes (MTImax, and MTImean) using diffusion weighted-MRI (DW-MRI) and positron emission tomography/computed tomography (PET/CT), and analyze the predictive and prognostic values of these biomarkers in a homogenous group of patients with advanced-stage laryngeal cancer.

Methods: Patients with newly diagnosed advanced-stage laryngeal cancer who had both DW-MRI and 18F-FDG PET/CT before treatment, and who had curative cancer treatment (surgery ± adjuvant therapy or radio ± chemotherapy) between 2011 and 2015 were included in this study. All patients were followed up clinically and radiologically, if necessary every 3 months for the first 2 years, every 4–6 months for year 3, and then annually thereafter.

Results: Thirty-eight patients were retrospectively analyzed. Our analysis demonstrated statistically significant differences when the pretreatment SUV and MTImean value were compared between patients with stages III and IV. Standardized uptake value was also a predictive factor for N-stage. Moreover, a statistically significant difference was determined when patients with and without perinodal involvement (PNI) were compared. Log rank analysis demonstrated that none of functional imaging-based biomarkers had a prognostic role for oncological outcomes.

Conclusion: Our results demonstrated that pretreatment SUV and MTImean values were predictive factors for staging, N-stage and PNI. Indeed, functional imaging-based biomarkers are promising, novel, noninvasive techniques that may provide additional information about tumor characteristics, treatment selection and prognosis in the near future.

Objective: The rise in the number of cancer cases with human papilloma virus (HPV)-positive squamous carcinoma of the oropharynx makes the detection of HPV clinically important. We aimed to investigate the HPV positivity in our patients who have oropharyngeal cancer and compare the two different HPV detection methods, which are HPV in situ hybridization (ISH) and p16 immunohistochemistry (IHC), and show the staining patterns.

Methods: Twenty-three specimens of oropharyngeal cancer patients and ten tonsillectomy specimens that revealed no cancerous tissue (control group) were collected from retrospective file analysis. All specimens were evaluated by both p16 IHC and HPV ISH on paraffin blocks.

Results: Seven of 23 cases showed p16 expression. Of all these 7 cases that showed p16 expression, six showed high p16 expression and one showed low p16 expression. All six cases that showed high p16 expression were HPV ISH (+). One case that showed low expression of p16 was HPV ISH (-). All cases that were p16 (+) showed diffuse p16 expression and none of the cases showed focal p16 expression.

Conclusion: High p16 expression (>70%) is a reliable marker of HPV positivity. Combining p16 IHC with HPV ISH will further improve its specificity. All p16 positive cases showed diffuse p16 expression, thus did not show tumor heterogeneity, suggesting that even a biopsy specimen showing diffuse p16 expression shows p16 positivity of the whole tumoral tissue.

Objective: Peripheral arterial tonometry (PAT) as a portable method of monitoring sleep quality is a relatively recent innovation. The aim was to compare the results of PAT and polysomnography (PSG) and to evaluate the role of PAT in diagnosing obstructive sleep apnea syndrome (OSAS).

Methods: This study included adult patients who admitted to ENT clinic with OSAS complaints (excessive daytime sleepiness, snoring, and witnessed apnea), undergone sleep monitorization using PAT system (WatchPAT 200TM; Itamar Medical Ltd., Caesarea, Israel) and had single-blind, level 1 polysomnography at sleep laboratory of Chest Diseases Department.

Results: For the two sleep monitoring sessions as conducted at different times: the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values were strongly correlated between sessions (r=0.749, r=0.753; p<0.001). The oxygen desaturation index (ODI) values were very strongly correlated (r=0.861; p<0.001). When the AHI scores calculated using PAT for the patients enrolled in the trial were taken into consideration; 89.7% of the patients were correctly diagnosed with OSAS (AHI≥5); for RDI calculated (RDI≥5) using PAT, 100% of OSAS diagnoses were correct; for AHI values calculated with the PAT method, taking 15 as cut-off point, the sensitivity was found to be at an extremely high level of 96.1%.

Conclusion: PAT and PSG values were highly correlated. This finding demonstrated that the reproducibility of the results obtained with PAT was also high. This study shows that PAT can be used as a screening test for OSAS and in a group of patients who are highly suspected for OSAS.

Objective: In this study, we aimed to compare ABR threshold values, V. wave latency times, amplitudes obtained using Click ABR and CEChirp ABR methods and procedural times of these tests in patients with bilateral hearing loss.

Methods: A total of 19 adult male patients were included in the study. ABR latency times with 10 dB decreases starting from 100 dB, V. wave latencies, V. wave amplitudes obtained using Click ABR and CE-Chirp ABR methods and procedural times were compared for both ears.

Results: Procedural time for CE-Chirp ABR test was found to be shorter than that of Click ABR test (p=0.001). For both ears, mean CE-Chirp ABR threshold values were more favorable than those of Click ABR test [(60.15±10.34 vs. 62.27±9.93) dB nHL, p<0.006]. For both ears, the threshold values of mean pure tone audiometry were estimated as following: 1 KHz (55.00±14.36 dB), 2 KHz (60.00±13.40 dB) and 4 KHz (63.48±10.57 dB). The corresponding values were calculated 62.27±9.93 dB nHL and 60.15±10.34 dB nHL using Click ABR and CE-Chirp ABR methods, respectively. Procedural time for CE-Chirp ABR test was shorter than that of Click ABR test [(24.89±4.74 vs. 28.63±4.98) min., p=0.001].

Conclusion: It has been determined that the use of CE-Chirp stimulus shortened ABR procedural time and provided responses closer to behavioral threshold values. In conclusion, we observed that CE-Chirp method was more advantageous than Click ABR method for the evaluation of the patients with bilateral sensorineural hearing loss.

Objective: We aimed to investigate whether climatic conditions of the region where we live and meteorological parameters had any effect on pathogenesis and prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) or not.

Methods: Sixty-eight ISSHL patients, who were treated in our department, were evaluated retrospectively. Meteorological data, including monthly ambient, maximum and minimum temperatures, relative humidity, atmospheric pressure and rainfall, were obtained from the observation station of the Central Weather Bureau of Sivas. The meteorological data for 10 days before the onset of the disorder and in a period of 21 days after the beginning of the treatment were used to investigate the relationship between climatic data and ISSNHL. Siegel’s criteria were used to evaluate the treatment success.

Results: The relationship between ISSNHL and seasons was observed to be statistically significant when the seasonal distributions of the cases were evaluated statistically (p<0.05; p=0.008). The change between Siegel’s criteria and season was also statistically significant (p<0.001). As recovery in hearing of cases with ISSNHL in accordance with Seigel’s criteria and meteorological parameters were evaluated, a statistically significant difference was determined in terms of weather temperature; minimum pressure, and rainfall in the period of 10 days before the treatment. However, when patients were evaluated based on meteorological variables in the period of 21 days after the treatment, there was a statistical correlation with the hearing recovery of the patients according to Siegel’s criteria only in terms of rainfall (p<0.005).

Conclusion: Our study is the first one indicating that there might be a relationship between rainfall and both pathogenesis and prognosis of ISSNHL. Even though the results of the related studies in the literature varied, we concluded that the relationship between ISSNHL and temperature, pressure, rainfall, and season should not be ignored.

Objective: Recently, the ratios of neutrophil to lymphocyte (NL) and platelet to lymphocyte (PL) have been used as an indicator of inflammation. We aimed to investigate the relation of recurrent aphthous stomatitis (RAS) to inflammation by analyzing the ratios of NL and PL.

Methods: We conducted a case-control study on 143 patients with RAS and 134 healthy control cases between February 2015 and March 2016. Age, sex, neutrophil count, platelet count, lymphocyte count, and the ratios of NL and PL of the participants were recorded.

Results: One hundred and forty-three RAS patients and 134 control cases were included in the study. The ratios of NL and PL of RAS group were significantly higher than in the control group (p=0.004 and p=0.010, respectively). The NL ratio was the only independent predictor of RAS in multivariate logistic regression analysis (p=0.014). The cut-off value of NL ratio for predicting RAS was 3.49 with 13.3% sensitivity and 99.9% specificity (p=0.010).

Conclusion: We have found that the ratios of NL and PL were higher in RAS group than the control group. The results of our study support that inflammation has an important role in the pathogenesis of RAS.

Objective: The aim of the present study was to determine the prevalence of the aeroallergens sensitivity among children with allergic rhinitis in the province of Istanbul in Turkey, based on skin prick test (SPT) reactivity.

Methods: This study, including 729 AR patients with positive SPT, was conducted in three age groups. SPT with extracts including pollens, house dust mites (HDMs), animal dander’s (ADs) and molds was performed on these patients. All these patients have a positive reaction to at least one allergen with SPT.

Results: The allergen prevalence of 729 patients with positive SPT results was 33% for HDMs, 31% for pollen, 19% for molds and 17% for ADs. The sensitivity to aeroallergens significantly decreased as the age increased (p<0.01). Both outdoor and indoor allergen positivity in preschool children (Group 1) were 89 (43.4%) and in adolescent children (Group 3) were 32 (15.6%), and also sensitivity to allergens significantly decreased according to increase of age (p<0.01).

Conclusion: We provided regional allergens profile of children with AR in Istanbul. Avoiding exposure to allergens and finding the best formulation of allergen immunotherapy for AR are important steps in the clinical management of patients.

Objective: This study aims to investigate the novel use of a simple and inexpensive bipolar-assisted tonsil reduction (B-TR) technique in pediatric cases with adenotonsillar hyperplasia by evaluating long-term results, possible complications, need for reoperation and incidence of recurrence.

Methods: We present our long-term retrospective data from 78 consecutive pediatric cases undergoing B-TR combined with adenoidectomy from April 2013 to January 2017. The tonsillar sizes were recorded using the Brodsky grading scale from I to IV, and the patients only with prominant tonsillar sizes (III and higher) and adenoidal sizes exceeding 50% were included in the study group. The tonsil sizes were noted preoperatively, and during the latest follow-up visit after tonsillotomy (min. 9 months postoperatively).

Results: With a mean follow-up period of 18.3 months, the mean tonsillar size preoperatively was 3.47 (±0.50) and mean tonsillar size postoperatively was 1.35 (±0.48). A significant difference (p<0.001) was observed between these two groups, excluding the only case who later had undergone tonsillectomy. Minimal uvular edema was noted in 27 children (34.6%), which did not cause any upper airway obstruction in these patients.

Conclusion: We describe herein our B-TR technique in details so that it can be learned relatively quickly and used in pediatric cases with adenotonsillar hyperplasia as a treatment option.

Objective: The differential diagnosis of submandibular triangle swellings can be challenging to the clinician. In this study, we retrospectively analyzed clinical and histopathological characteristics of these swellings referred to our clinic and integrated our results with current literature in terms of various diagnostic aspects.

Methods: A total number of 64 transcervical submandibular gland extirpations were reviewed and evaluated regarding age, gender, fineneedle aspiration biopsy and specimen reports.

Results: This study comprised 34 male (53.1%) and 30 female (46.9%) patients. We classified submandibular triangle swellings clinicopathologically as tumoral and non-tumoral lesions for better evaluation. We had 15 patients with primary epithelial submandibular gland neoplasm, 10 (66.7%) of them were benign cases, all of the benign cases were pleomorphic adenoma with a male to female ratio of 1:2.33 and a mean age of 30.8 years, 5 (33.3%) of them were malignant with a mean age of 55 years. There were also 37(57.8%) patients with chronic sialadenitis associated with sialolithasis, 1 (1.6%) had acute sialedenitis, 2 (3.1%) had granulomatous sialadenitis, 2 (3.1%) had reactive cervical lymphadenopathy and 5 (7.8%) were treated for cystic lesion removal. Ultrasonography and fine needle aspiration cytology were our major diagnostic tools for differential diagnosis. Our institution’s sensitivity of fine-needle aspiration cytology for identifying malignancy was 60% and the specificity was 100%.

Conclusion: Submandibular gland excision for primary lesions has relatively low incidence compared with other surgical implications. Although chronic sialadenitis caused by symptomatic sialolithiasisis the most frequent indication for surgery, diverse clinical entities should be ruled out for differential diagnosis of swellings of this region.

Papillary cystadenoma lymphomatosis (Warthin’s tumor) is the second most common benign neoplasm of the parotid gland. Although the tumor usually presents as a slowly growing mass in the tail of the parotid gland, extraparotid involvements such as the cervical lymph nodes may be observed rarely. In this article, we aimed to report a Warthin’s tumor case with atypical presentation. A 68-year-old male patient with the history of smoking was admitted to our clinic with the complaint of rightsided neck lump. After physical examination and imaging, excisional biopsy was performed with an initial diagnosis of cervical lymphadenopathy. Pathology result was reported as Warthin’s tumor. Five months later, multicentric Warthin’s tumor in the contralateral parotid gland was diagnosed and operated. With this case report, we want to emphasize that Warthin’s tumors may rarely present as a neck lump outside the parotid gland, and we want to review relevant literature data.