Deniz Tuna Edizer

Nasal Sound Analysis: A New Method for Evaluating Nasal Obstruction in Allergic Rhinitis

Objective: Current measurements of nasal obstruction are unreliable and may be improved with the development of new techniques. The effectiveness of odiosoft‐rhino (OR) in the evaluation of nasal obstruction was investigated in a blind comparison at a referral center, institutional practice.

Management of paragangliomas in otolaryngology practice: review of a 7-year experience.

Background and Aims:Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. Materials and Methods:Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy. Results:Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief. Conclusions:The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.

Primary Tuberculosis Involving Epiglottis: A Rare Case Report

The case of a 29-year-old patient with active laryngeal tuberculosis predominantly involving the epiglottis, without pulmonary disease, is presented. The predominant symptoms are dysphagia, odynophagia, and hoarseness. Laryngeal carcinoma, which shares almost the same symptoms and signs, should be ruled out immediately. Laryngeal tuberculosis is discussed with a brief literature review.

Odiosoft-Rhino versus rhinomanometry in healthy subjects.

Conclusion. Odiosoft-Rhino (OR) is a non-invasive test that is completed in an extremely short period of time. It is easy to perform and little patient cooperation is needed. OR is safe and could be used in the rhinological setting if further improved. Objective. To evaluate nasal obstruction objectively with a new technique, OR, and to compare the results with a widely accepted method, rhinomanometry, in normal subjects. Subjects and methods. OR and anterior RMM were performed in 79 subjects without any rhinologic symptoms and signs. Visual analogue scales (VAS) of nasal obstruction, nasal airway resistance and nasal expiratory and inspiratory sounds were analysed. Results. VAS of nasal obstruction was found to be correlated with OR findings of expiration at 2000–4000 Hz frequency interval on both sides (r=0.564, p<0.01 for the left side, r=0.533, p<0.01 for the right side). Correlations were found (p<0.05) between left 2000–4000 Hz in expiration OR and left expiration RMM, left 4000–6000 Hz in expiration OR and left expiration RMM, right 2000–4000 Hz in expiration OR and right expiration RMM, and right 4000–6000 Hz in expiration OR and right expiration RMM. No correlation was seen between VAS, anterior RMM and OR at inspiration in any interval.

Hypoglossal schwannoma presenting only with headache.

Hypoglossal schwannoma is a rarely encountered skull base lesion that has generally both intracranial and extracranial parts. This article reports a case of hypoglossal schwannoma that is purely extracranial and presents itself only with persistent headache. Magnetic resonance imaging delineated a mass at the skull base that consisted of both cystic and solid components, consistent with a nerve sheath tumor. Cervical approach was chosen, and the mass was completely removed. Postoperatively, the patient developed hypoglossal nerve palsy because the hypoglossal nerve was sacrificed. Hypoglossal schwannomas are briefly discussed with a literature review.

Evaluation of laryngeal findings in users of inhaled steroids

The objective of the prospective study is to examine the laryngeal changes by laryngeal videostroboscopy and electromyography (EMG) regarding new-onset dysphonia in asthmatic patients taking inhaled corticosteroids (ICS). Laryngeal changes and electrophysiological status of the laryngeal muscles were evaluated by these methods in 12 patients both at the time of presentation of dysphonia and after cessation of therapy. Laryngeal changes of our patients were mucosal edema, erythema, thickening, adduction deficit, nodule and irregularity in videostroboscopy. Significant correlations were found between laryngeal pathology and dosage and duration of ICS therapy. We detected myopathy by EMG in most of the patients. Also, EMG revealed that cricothyroid muscle was much more affected than thyroarytenoid muscle. In conclusion, we consider that steroid myopathy or mucosal inflammatory theory alone is not sufficient to explain the etiopathogenesis of dysphonia in asthmatic patients taking ICS. The laryngeal mucosal changes were detected by laryngeal videostroboscopic examination in some asthmatic patients, with dysphonia using ICS, and/or laryngeal myopathy was found by laryngeal EMG in some of them in this study. Thus, various factors may have role simultaneously in the occurrence of dysphonia.

Alveolar soft part sarcoma of the larynx

Alveolar soft part sarcoma (ASPS) is a rare malignancy. It has generally a poor prognosis. Survival depends on the presence of metastases. Approximately, one-fourth of the cases are encountered in the head and neck region, mostly in the orbits and tongue. Surgery is accepted as the most effective treatment, radiotherapy and chemotherapy may be used as adjuvant treatments. Since it is a highly vascular tumor, profuse bleeding may occur during surgery. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor. To our knowledge, only three cases of laryngeal ASPS have been previously reported in the English literature.

Nasal Expiratory Sound Analysis in Healthy People

OBJECTIVE: To evaluate the practicability of Odiosoft-Rhino (OR), a new experimental method for assessing the nasal airflow and resistance, in normal subjects and to compare the results with acoustic rhinometry (AR) findings. STUDY DESIGN AND SETTING: OR and AR were carried out in 72 healthy subjects. Their visual analogue scales of nasal obstruction, minimal cross sectional areas (MCA1 and MCA2), and nasal expiration sounds were analyzed and noted for both nasal cavities. RESULTS: Statistically significant correlations (P < 0.05) were found between OR and AR in 2,000 to 4,000 Hz and 4,000 to 6,000 Hz with MCA1 and MCA2. CONCLUSIONS: OR is a noninvasive and rapid test. It is easy to carry out and requires little patient cooperation. It seems that it may give compatible results with other reliable methods that assess nasal airflow. SIGNIFICANCE: We assume that OR is a sensitive method for evaluating nasal airflow in normal subjects in an easy way. EBM rating: A-1b

Extranodal sinonasal natural killer/T-cell lymphoma presenting as chronic sinusitis and necrotic wound infection.

A case of a 43-year-old white woman who was admitted to our clinic with the complaints of chronic sinusitis and wound infection after Caldwell-Luc operation performed for chronic sinusitis is presented. Necrotic lesion then extended to the nasal cavity and skin of the face. The biopsy revealed natural killer/T-cell lymphoma. The patient was treated with chemotherapy; however, the patient died owing to sepsis. Sinonasal lymphoma is a rare disease. It is managed with chemotherapy and radiotherapy. The prognosis is poor. A high index of clinical suspicion is required for early diagnosis.

Electrophysiologic Evaluation of the Facial Nerve and Blink Reflex Pathways in Asymptomatic Cochlear Implant Users

Objective To evaluate the functional integrity of the facial nerve and blink reflex (BR) pathways in asymptomatic patients who underwent cochlear implantation (CI). Study Design Case series with planned data collection. Setting Tertiary referral center. Subjects and Methods Twenty-four deafened patients with unilateral CI who had no complications were enrolled. Bilateral compound muscle action potentials (CMAPs) of the facial nerve were recorded over the nasalis and occipitalis muscles, whereas BR responses were recorded over the orbicularis oculi after supraorbital nerve stimulation. All recordings were performed when the external part of the implant was in place (CIp) and after its removal (CIr), except occipitalis recordings, which were performed only after removal. The amplitude and latency of CMAP were measured to evaluate the axonal integrity of the zygomatic and posterior branches of the facial nerve. Latency, amplitude, and duration of the BR were measured to investigate the integrity of trigeminofacial connections. Results The amplitude and latency of CMAP over the nasalis muscle were bilaterally normal, and the difference between CIp and CIr was not statistically significant. No CMAP of the occipitalis muscle was recorded in 4 (16.7%) patients, and low-amplitude responses were recorded on the implant side of 20 (83.3%). Amplitudes of the contralateral R2 response were higher in the CIp condition versus the CIr condition (P = .031). There were no differences among other BR components. Conclusion During functioning of the CI system, excitability of the facial circuit may increase either through the facial motor nucleus or through removal of the inhibitory effect of the descending pathway.