Bahar Keles

Jugular foramen tumors: clinical characteristics and treatment outcomes.

Objective: To describe the diagnosis, management, and treatment outcome of jugular foramen (JF) tumors. Study Design: Retrospective chart review. Methods: Charts of the 83 patients diagnosed with JF tumors between January 1997 and May 2008 were reviewed. Presenting symptoms, otologic and neurotologic examination, audiologic thresholds, treatment procedure, surgical technique, tumor size and classification, and postoperative complications were recorded. Facial nerve function was graded using the House-Brackmann scale. Extent of tumor removal was determined at time of surgery, followed by routine radiographic follow-up. Results: The mean age of patients with JF tumors was 48.5 years (standard deviation, 16.3 yr), and women (79.5%) outnumbered men (20.5%). Most had glomus jugulare (GJ) tumors (n = 67, 80.7%); 9 patients had lower cranial nerve schwannomas (10.8%), and 7 patients had meningiomas (8.4%). The most frequent initial symptoms included pulsatile tinnitus (84.3%), conductive hearing loss (75.9%), and hoarseness (34.9%). Sixty-one patients (73.5%) underwent surgery, 18.1% had radiotherapy, and 8.4% were observed. Total tumor removal was achieved in 81% of surgery cases. New lower cranial nerve (CN) deficits occurred after surgery in 18.9% of GJ, 22.2% of schwannoma, and 50% of the 4 meningiomas. At last follow-up, 88.1% of surgical patients had normal or near-normal (House-Brackmann I or II) facial function. Conclusion: Total resection of GJ tumors, meningiomas, and lower CN schwannomas can be a curative treatment. However, subtotal removal may be required to preserve CN function, vital vascular structures, and the brainstem. Postoperative radiotherapy is used to control residual tumor. When postoperative complications develop in patients, early rehabilitation is important to decrease mortality and morbidity. Therefore, patients should be closely followed.

Effectiveness of MeroGel hyaluronic acid on tympanic membrane perforations

Conclusions. Our results support the proposition that hyaluronic acid (HA) provides a moist wound-healing environment to aid in the healing process of tympanic membrane perforation. A single MeroGel administration can be effective as well as daily topical HA application in the treatment of tympanic membrane perforations. A single application of esterified HA may be more suitable for patients and also for otolaryngologists. Objective. The purpose of the present study was to evaluate the effectiveness of a single MeroGel application on traumatic tympanic membrane perforations in rats. Materials and methods. The posterior quadrant of the tympanic membranes in both ears of 24 male pathogen-free Sprague-Dawley rats was perforated with a 20-gauge needle. Subjects were divided into two groups: MeroGel and daily topical HA-treated groups. All subjects were sacrificed and histopathological examinations of the tympanic bullas were carried out. Results. Perforations of controls, and MeroGel- and daily HA-treated groups closed in 17/24 (70.8%), 11/12 (91.7%), and 12/12 (100%) ears, respectively. There was a significant difference between control and MeroGel-treated groups, and also between control and daily topical HA-treated groups for the presence of vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), lymphocytes and collagen fibrils (p<0.05), whereas there was no significant difference between MeroGel- and daily topical HA-treated groups (p>0.05).

Pharyngeal Reflux in Children with Chronic Otitis Media with Effusion

Objective—To investigate whether there is an association between chronic otitis media (COM) with effusion and pharyngeal reflux in children by using 24-h pH monitoring with a dual probe. Material and Methods—This was a prospective study. The study group consisted of 25 children with COM with effusion and the control group comprised 12 healthy children. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring). Results—In the study group, the frequencies of pharyngeal and gastroesophageal reflux (GER) were 48% and 64%, respectively, and the corresponding values in the control group were 8.3% and 25%. Both of these differences were significant (p<0.05). In the study group, 28% of patients were positive for at least 1 symptom of GER; 72% of the patients did not have any symptoms but 56% of these patients had silent GER. Conclusions—These findings indicate that pharyngeal reflux may play an important role in the etiology of COM with effusion. If patients have typical symptoms of GER, such as pyrosis, regurgitation, dysphagia and emesis, the presence of GER should be considered. The presence of silent GER and pharyngeal reflux should also be considered.

Juvenile Ossifying Fibroma of the Mandible: a Case Report

ABSTRACT Background Fibro-osseous lesions of the jaws, including juvenile ossifying fibroma, pose diagnostic and therapeutic difficulties due to their clinical, radiological and histological variability. The aim of this study was to report the outcome of a 9 years old girl with diagnosed juvenile ossifying fibroma treatment. Methods A 9 years old girl presented with a 6 x 8 cm sized hard fixed tumour on right ramus and corpus of the mandible. On the radiological examination tumour showed an irregular but well bordered, unilocular and expansive lesion on the right corpus and ramus of the mandible. There was no teeth displacement or teeth root resorbtion. Microscopically, the tumour had trabeculae, fibrillary osteoid and woven bone. After the clinical, radiological (panoramic radiography, computed tomography and magnetic resonance imaging) and histologic analysis it was diagnosed juvenile ossifying fibroma. In the history of the patient there has been an acute lymphocytic leukaemia in the remission for 3 years. Results Because of large size of mandibular tumour, resultant expansion and destruction of mandibular cortex, the patient underwent right hemimandibulectomy using transmandibular approach. There was no recurrence or complications for two years follow-up. Conclusions Although juvenile ossifying fibroma is an uncommon clinical entity, its aggressive local behaviour and high recurrence rate means that it is important to make an early diagnosis, apply the appropriate treatment and, especially, follow-up the patient over the long-term.

The use of adjunctive topical mitomycin in endoscopic congenital choanal atresia repair

OBJECTIVE To evaluate the efficacy of topical mitomycin in providing the patency of the neochoanae in children undergoing transnasal endoscopic congenital choanal atresia (CA) repair. METHODS A retrospective analysis of surgical results in CA patients who were treated in Selcuk University, Meram Medical Faculty, Department of Otolaryngology between November 2002 and November 2009 was performed. All patients underwent transnasal endoscopic approach using nasal telescopes and traditional sinus instrumentation together with a microdebrider. Mitomycin was used according to the senior surgeons preference, and certainly not in a randomized fashion. After completion of surgery, mitomycin 0.4 mg/ml was applied to the neochoanae for 3 min. Postoperative stenting was performed in all patients. RESULTS CA was unilateral in 8 subjects (mean age 71.8+/-41.7 months; range 18 months-144 months) and bilateral in 12 subjects (mean age 4.6+/-1.3 days; range 3-7 days). Among the subjects, 75% was female in both groups. Fourteen subjects under endoscopic repair without mitomycin, whereas mitomycin was used in 6 patients (4 bilateral, 2 unilateral). Stents were left at least 3 weeks postoperatively (mean 31+/-10 days; range 21-45 days). The patients were followed-up at least 6 months (range 6-72 months). No symptomatic restenosis requiring further dilatations was seen in patients treated with preoperative mitomycin, whereas restenosis was detected in 6 subjects (42.9%) treated without mitomycin postoperatively within 6 months period (Fishers Exact Test 2-sided, p=0.12). These subjects underwent revision endoscopic repair with mitomycin and had no need for further dilatations with acceptable control of symptoms during a follow-up period ranging between 14 and 78 months. CONCLUSION Mitomycin improves the surgical treatment outcome of CA and reduces the rate of restenosis significantly without any complications. However, further prospective randomized studies are needed to fully investigate the benefits of mitomycin therapy in CA surgery.

Comparative Effects of Alpha Lipoic Acid and Melatonin on Cisplatin-Induced Neurotoxicity

ABSTRACT Cisplatin is a carcinogenic agent having important cytotoxic effects. Cisplatin treatment increases the levels of free oxygen radicals in neurologic tissues. We investigated the effects of alpha lipoic acid (ALA) and melatonin (MEL) on the electrophysiological parameters and on activities of nerve fibers having different conduction properties on cisplatin neurotoxicity. Neurotoxicity was induced by a single injection of 10 mg/kg intraperitoneal (ip) cisplatin. Supplementation was started 1 day before cisplatin injection with either 100 mg/kg/day ip ALA or 4 mg/kg/day ip MEL for 7 days. Compound action potentials were recorded from isolated sciatic nerves in vitro, and numerical analyses were conducted. Cisplatin-induced neurotoxicity resulted in a significant decrease (p <.05) in maximum depolarization (mV), areas (mV·ms), and maximum and minimum upstroke velocity values (mV/ms). Although these decrements were restored by ALA and MEL, ALA was found to be more effective. Conventional conduction velocity measurements and conduction velocity distribution histograms have shown that ALA supplementation can recover the effects of cisplatin while MEL cannot. The conduction velocity distribution histograms have shown that antioxidant supplementation results in a restoration on contribution of fast-conducting fibers (51.8–77.7 m/s), which is deteriorated by cisplatin. Consequently, ALA has more potential to make up for the deleterious effects of cisplatin-induced neurotoxicity.

Evaluation of HLA-A, -B, -Cw, and -DRB1 alleles frequency in Turkish patients with nasal polyposis.

Objective To evaluate whether there is a relationship between HLA-A, -B, -Cw, and -DRB1 alleles and developing nasal polyposis (NP). Study Design Data from 66 patients with NP were compared with data from 100 healthy randomly selected controls. Asthma, ASA (acetylsalicylic acid) triad, polyp score, and previous sinonasal surgery were also recorded. Subjects and Methods Genotyping of the HLA-A, -B, -Cw, and -DRB1 alleles were performed with polymerase chain reaction (PCR) with the sequence-specific primer (SSP) method. Data were analyzed by using a Pearson χ 2 test. Results The HLA-B*07 and -Cw*12 alleles were found to be significantly higher in the NP patients compared with the control group, whereas the HLA-B*57 and HLA-Cw*04 alleles were significantly lower (P < 0.05). The HLA-A*24, HLA-Cw*12, and HLA-DRB1*04 alleles were determined to be significantly higher in the NP patients with asthma and ASA triad (P < 0.05). Conclusions Our results show that some of the HLA alleles seem to be associated with the genetic susceptibility to develop NP in the Turkish population.

The morphometric development of the fetal larynx during the fetal period

OBJECTIVE The aim of the present study was to investigate morphometric growth patterns of the cartilaginous components and vocal cords in human fetal larynx. METHODS This study was performed in the Anatomy Department of Meram Medicine Faculty in 2007. The fetuses were obtained from the Gynaecology Department of the Meram Medicine Faculty of Selcuk University, and Dr. Faruk Sükan Maternity Hospital (Konya, Turkey). Forty spontaneously aborted fetuses (25 males and 15 females) without detectable malformations were evaluated. The dimensions of the larynx and its cartilaginous components were measured and the relationship between the obtained data was statistically assessed with Students t-test. RESULTS Correlations were found between the cartilaginous components, size of the larynx, and gestational age. No gender differences were identified. The anatomical variations in the epiglottis cartilage dimensions and types were found in 15% of cases. The foramen thyroideum was observed in 12.5% of cases. CONCLUSION The data of this study may contribute to the knowledge of the fetal larynx regarding laryngomalacia.

Penetrating zone II neck injury by broken windshield

All penetrating neck wounds are potentially dangerous and require emergency treatment because there are important vessels, nerves and organs in the neck. We present the case of a patient who had an unusual penetrating neck injury caused by a broken windshield, noticed accidentally. Because fragments of windshield glass consist of sharp material, and the neck contains vital structures, such penetrating neck injury may cause life‐threatening complications. Radiological examinations should be offered before the management of all neck wounds. The risk of retained foreign bodies and related complications can be prevented by using fluoroscopy during surgical exploration of the neck.

Anterior atticoantrostomy for cholesteatoma surgery.

Objectives: We aimed to investigate the long-term results of anterior atticoantrostomy in adult patients with cholesteatoma. Methods: A total of 83 ears in 78 patients were operated on by the anterior atticoantrostomy technique, supported by a periosteal flap, between 1991 and 2002. Results: Cholesteatoma recurred in only 4 ears (4.8%). In the 79 ears without recurrence, re-perforation was observed in 3 ears (3.8%), and retraction pockets developed in the attic of 5 ears (6.3%), 2 of which needed ventilation tubes. Absorption or migration of cartilage grafts was not seen in any of the patients. The mean air-bone gap was 34.8 ± 13.4 dB and 16.9 ± 14.7 dB, and the mean high-tone bone conduction was 19.0±6.2 dB and 21.1 ±6.6 dB, in the preoperative and postoperative periods, respectively. Conclusions: In the reconstruction of the posterior canal wall, a cartilage graft supported by a periosteal flap prevents attic retraction and may increase the vascularization of the graft. After anterior atticoantrostomy, the recurrence rate and the probability of leaving residual tissue are low. Therefore, we believe that anterior atticoantrostomy is a relatively safe and effective technique that can be used in the management of cholesteatoma.