Coşkun H

Is it the middle ear disease or the reconstruction material that determines the functional outcome in ossicular chain reconstruction

Objectives To evaluate the effects and the predictive value of environmental risk factors on the success of different reconstruction materials used in ossiculoplasty. Study Design Retrospective case review. Setting Tertiary referral university hospital. Patients Between January 2007 and October 2010, 110 patients who underwent ossiculoplasty with or without mastoidectomy due to chronic otitis media were enrolled in the study. All patients were classified into 1 of the 3 risk groups (mild, moderate, and severe) according to their measured Middle Ear Risk Index score. Interventions The patients underwent exploratory tympanotomy, tympanoplasty, or tympanomastoidectomy (canal wall-up or wall-down), all with ossicular reconstruction. The ossicular reconstructions were performed using either bone cement, autologous bone interposition, or allograft material. Main Outcome Measures For each patient, the air-conduction threshold and air-bone gap (ABG) were measured at the 12th month after ossiculoplasty. The ABG gain and air-conduction improvement were compared with preoperative values. The correlation of the success of ossiculoplasty with the middle ear risk group of patients was investigated. Moreover, the efficacy of different types of reconstruction material on the success of ossiculoplasty in the same risk group was evaluated. Results In the mild- and moderate-risk groups, the ABG gain (p = 0.001 and p = 0.014) and air-conduction improvement (p < 0.001 for both) were statistically significant, whereas those changes were found to be insignificant in the severe-risk group. Moreover, the ABG gain and air-conduction improvement in none of the risk groups revealed a significance in favor of any of the used reconstruction materials. Conclusion The results of this study revealed that none of the reconstruction materials or specific techniques have a superiority in the functional outcomes in patients from the same middle ear risk group. We conclude that the success of ossiculoplasty is highly correlated with the pathophysiological status of the middle ear and is independent of the type of replacement material.

The role of selective neck dissection in pathological N1 squamous cell carcinomas of the head and neck.

OBJECTIVES This study aims to evaluate the effectiveness of selective neck dissection (SND) in stage pN1 head and neck cancers. PATIENTS AND METHODS Patients who underwent neck dissection due to squamous cell carcinoma of oral cavity, larynx, oro-hypopharynx were evaluated retrospectively. Sixty-one patients diagnosed with pathological N1 by neck dissection were included in the study. Thirty-four of the 61 necks, to which SND was applied, comprised the study group, and 27 necks, which underwent comprehensive neck dissection (CND), comprised the control group. RESULTS Neck recurrence rates were 4.9% for all cases, 5.9% for the SND group and 3.7% for the CND group. Two- and five-year disease-specific survival rates were similar for SND group (78.6%, 72.5%) and CND group (90.5%, 82.9%). Two- and five-year overall survival rates were also similar for SND group (67.6%, 58%) and CND group (81.5%, 66%). None of them were significantly different between groups (p>0.05). CONCLUSION Selective neck dissection provides comparable results to CND in the treatment of pN1 necks.

Prognostic significance of soft tissue deposits in laryngeal carcinoma

INTRODUCTION Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. OBJECTIVE To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. METHODS Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. RESULTS The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. CONCLUSION In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Should Nasal Function be Considered Prior to Tympanoplasty

OBJECTIVE To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM). MATERIALS AND METHODS The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month. RESULTS Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%. CONCLUSION Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.

Impact of Septoplasty on Eustachian Tube Functions

Objective: To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions. Material and Methods: The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months. Results: Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group. Conclusions: Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.

An evaluation of the results of chemoradiotherapy and surgical treatment for hypopharyngeal cancer.

OBJECTIVES This study aims to evaluate the efficacy chemoradiotherapy and surgical treatment in patients with hypopharyngeal cancer. PATIENTS AND METHODS Between January 2003 and July 2009, 48 patients (31 males, 17 females; mean age 55.5±13.4 years; range 29 to 84 years) who were diagnosed with hypopharyngeal cancer were retrospectively evaluated. The patients were assigned into surgery (n=17) and chemoradiotherapy (n=31) groups. RESULTS The overall survival of the patients with advanced disease in the surgery group was statistically higher than those in the chemoradiotherapy group. The recurrence rate of the patients was 35.3% in the surgery group, whereas it was 41.4% in the chemoradiotherapy group. CONCLUSION Our study results indicated that the survival rates were higher in the surgery group. On the other hand, chemoradiotherapy had the advantage of laryngeal preservation.

Galvanic skin response test: a new quantitative diagnostic method for Frey syndrome.

ObjectiveFrey syndrome is one of the most common complications following parotid surgery. The current most common test for objectively diagnosing Frey syndrome is Minor starch-iodine test. This test might be insufficient because its results are not quantitative and therefore tests with quantitative results are investigated. The objective of this study was to investigate the efficiency of galvanic skin response (GSR) test, which measures changes in skin resistance, as a method with quantitative results for diagnosis of Frey syndrome. MethodsThirty patients who underwent superficial parotidectomy were assessed postoperatively (mean, 24.7 ± 25.7 months; range, 6–109 months). Patients completed a symptomatic evaluation questionnaire and underwent Minor starch-iodine test and GSR. ResultsDiagnostic validity of GSR test was found to be >2.91 following analysis. Sensitivity and specificity of this value were 100% and 55%, respectively, based on symptomatic assessment. Sensitivity and specificity were 87.5% and 57.1%, respectively, based on Minor starch-iodine test. ConclusionsWhen compared to symptomatic evaluation of patients who underwent superficial parotidectomy, GSR test was shown to be 100% sensitive in diagnosing Frey syndrome and quantitative results of GSR test could determine severity of Frey syndrome.