Celil Uslu

The role of computed tomography scanning in chronic otitis media.

The purpose of this study was to determine the role of high-definition computed tomography (CT) in chronic otitis media (COM) patients and to present which parameters were useful or misleading for preoperative evaluation for management. Fifty cases of COM that underwent preoperative CT scanning at a tertiary referral center were retrospectively analyzed. Their CT scan reports were compared with the operative findings. The patients had undergone tympanoplasty with or without mastoidectomy for COM between April 2008 and January 2010. Patient charts were used to obtain the necessary data. In 62% (31/50) of cases, the CT scan showed the presence of cholesteatoma. Operative findings revealed cholesteatoma in 61.8% (19/31) of these cases. However, when a bone eroding soft tissue mass involved the epitympanum on CT, the presence of cholesteatoma was observed in 83.3% (15/18) of cases intraoperatively. Cholesteatoma was present in the mastoid or middle ear intraoperatively in 77.7% (7/9) of patients with an external ear bony canal defect found on CT. Despite 89.7, 85.29, and 90% agreement ratios for dehiscence of facial canal, lateral semicircular canal, and tegmen, respectively, CT could not detect dehiscence of these anatomic structures successfully. Based on these results, CT scanning has limitations but is a useful adjunct for the surgical management of COM patients.

Cartilage reinforcement tympanoplasty: otological and audiological results

Abstract Conclusion: High risk perforations including total, subtotal, atelectatic perforations, those with cholesteatoma and revision cases can be treated efficiently with cartilage reinforcement tympanoplasty. Objective: The purpose of this study was to describe the perforation closure rates and hearing results of cartilage reinforcement tympanoplasty. Methods: This was a retrospective chart review and included 60 patients who underwent surgery with the cartilage reinforcement technique between November 2006 and October 2008 at the Department of Otorhinolaryngology of Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey. The male to female ratio was 28 (46.7%)/32 (53.3%). The mean age of the patients was 30.10 ± 11.50 years (range 13–55). Results: Preoperatively, only one patient had a retraction pocket but not a perforation, 12 (20%) patients had perforation of < 25% of the total tympanic membrane diameter, 12 patients had perforation between 25% and 50% of the total membrane diameter, 18 patients had a perforation between 50% and 75% of total membrane diameter and 17 patients had a perforation of > 75% of the total membrane diameter. Postoperatively we achieved total closure of tympanic membrane perforations for 47 patients but the perforations of 13 patients remained in various sizes (7 patients had tympanic membrane perforation < 25% of the total membrane diameter, 3 between 25% and 50%, 2 between 50% and 75% and 1 patient had a perforation > 75% of the total membrane diameter). There was a statistically significant difference between percentages of preoperative perforation and postoperative perforations (p = 0.001). Only 1.7% of patients had no perforation preoperatively and this ratio increased to 78.3% postoperatively. Also, 30% of patients had a perforation between 50% and 75% of the total membrane diameter, 28.3% of the patients had a perforation > 75% of the total membrane diameter preoperatively and this ratio decreased to 3.3% and 1.7%, respectively. Concerning the audiological parameters, the difference between preoperative and postoperative hearing levels was statistically significant (p = 0.001).

Tuberculosis of the epiglottis: a case report

We present a 40-year-old woman with pulmonary tuberculosis and epiglottic involvement that was initially misdiagnosed as laryngeal carcinoma. The differential diagnosis and management of epiglottic tuberculosis is reviewed and discussed. Although epiglottic tuberculosis is rare, otorhinolaryngologists should keep in mind the possibility of tuberculosis in the differential diagnosis of laryngeal tumors. Constitutional symptoms and mild chest symptoms should not always be attributed to carcinoma and smoking.

99mTc-labelled red blood cell single-photon emission computed tomography for the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma.

AimTo confirm the usefulness of blood pool scintigraphy with 99mTc-labelled red blood cells (99mTc-RBCs) in the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma. MethodsA prospective study design was used. 99mTc-RBCs were prepared by a modified in-vivo method. After the rapid intravenous injection of 370–740 MBq of 99mTc-RBCs, dynamic imaging of 1-min duration was performed. After dynamic imaging, static acquisitions at 5 min (second phase: blood pool phase) and 2 h (third phase: static image) were obtained. In addition, single-photon emission computed tomography (SPECT) imaging was performed at 2 h. SPECT images were obtained using a rotating gamma camera (GE-Starcam 4000 XR/T). ResultsAll patients showed no activity in the first phase and mild activity in the second phase (blood pool phase). All patients with juvenile nasopharyngeal angiofibroma showed a prominent increased activity in the third phase and in SPECT images. ConclusionsThis study shows that blood pool scintigraphy with 99mTc-RBC SPECT is very accurate, easy to perform and a suitable alternative to pre-operative and post-operative imaging techniques, including computed tomography scan, magnetic resonance imaging (MRI) and MRI angiography, for the detection of juvenile nasopharyngeal angiofibroma.