Devrim Bektas

Oral teratoma: a case report and literature review

Teratomas are true neoplasms composed of tissues from all three germinal layers. They have an unknown origin and eccentric microscopic appearance. Teratomas arising from the oral cavity are rare in the newborn; only 13 cases have been reported in the literature. We describe a male neonate with an oral teratoma originating from the anterior hard palate that was successfully treated with surgery.

Otolaryngologic aspects of tetanus

Abstract. Tetanus is considered a major health problem in the developing and under-developed countries, with approximately 1 million new cases occurring each year. We have evaluated the tetanus patients and their presenting complaints, the clinical findings and their relations to the head and neck region along with the frequency of otolaryngological findings and their correlation to the prognosis of this highly mortal disease. There were a total of 37 patients with generalized tetanus diagnosed and treated between 1991 and 2001. There were 25 women and 12 men with a mean age of 55±15.6 years. The most common presenting symptom was trismus, followed by neck pain, dysphagia, generalized pain and facial muscular contractions. Wound evaluation revealed that 72.9% of the patients had tetanus-prone wounds, and 27% had either no obvious wounds or a wound considered to be trivial by the patient. Only 62% percent of the patients had sought medical attention immediately after being injured. Three patients in our series were admitted to the otolaryngology clinic with upper aerodigestive tract symptoms. A comparison of complaints with clinical findings revealed a significant lack of correlation, emphasizing that complete physical examination must be performed when evaluating patients with trismus, dysphagia and neck pain. Tracheotomy was performed in 21 cases. There was a direct correlation between the clinical stage and the requirement of tracheotomy. Wound debridment was performed, and antibiotherapy, tetanus toxoid vaccine and immunoglobulin were administered. The mortality rate was 59.4% (22/37). Shorter incubation periods and periods of onset and a higher grade of disease were significantly related to high mortality rates (P=0.001). It is important to realize the fact that instead of looking for tetanus-prone wounds, one should be on the lookout for tetanus-prone patients. Consequently, on the part of the otolaryngologist, there should always be a high index of suspicion, and concerning patients with trismus or subacute progressive dysphagia, the possibility of tetanus must be borne in mind.

VEMP responses are not affected in non-insulin-dependent diabetes mellitus patients with or without polyneuropathy

Conclusion. Vestibular evoked myogenic responses (VEMPs) are not affected in non-insulin-dependent diabetes mellitus (NIDDM) patients with or without polyneuropathy. Objective. To compare VEMP responses of NIDDM patients and healthy subjects. Subjects and methods. VEMP responses were collected from 25 NIDDM patients with polyneuropathy (PNP), 13 NIDDM patients without PNP and 21 healthy subjects using click stimulation. After excluding ears with hearing loss (HL) (worse than 25 dB) the VEMP responses (p13 and n21 latencies and amplitude) recorded in 105 dB stimulus intensity were compared. Results. There was no statistically significant difference between groups. VEMP responses were found to be normal in NIDDM patients with or without PNP.

Effects of adenoidectomy in children with symptoms of adenoidal hypertrophy

The purpose of this study was to compare the preoperative symptoms of children who had adenoid hypertrophy with postadenoidectomy symptoms. Sixty children undergoing adenoidectomy were included in this prospective uncontrolled study at the Farabi Hospital of Karadeniz Technical University, an academic tertiary medical center. The symptoms of each child were described by their parents. Adenoidectomy with myringotomy alone or with tympanostomy tube placement was performed in all children. Two months after the operation, the children were re-evaluated for remaining or residual symptoms. Nasal obstruction, mouth breathing, snoring, hearing loss and nasal discharge were present preoperatively in 55 (91.6%), 51 (85%), 50 (83%), 28 (46%) and 45 (75%), respectively. We found that 53 of 60 children (88.3%) completely recovered from their preoperative symptoms. Of the remaining seven patients, four had persistent nasal obstruction, five mouth breathing, three snoring and two hearing loss. We also noted that the parents of 53 of 60 children were satisfied after the operation. Adenoidectomy provided significant relief and improvement of preoperative presenting symptoms, and it also showed a high rate of parent satisfaction.

Sialolithiasis of an accessory parotid gland

We report a case of sialolithiasis of an accessory parotid gland in the cheek demonstrated by computed tomography and sialography. The accessory parotid gland was located anterolateral to the masseter muscle and was isolated from the main parotid gland. The calculus developed from this accessory parotid gland, and the main parotid gland was free of sialolithiasis and inflammation. To our knowledge, this is the first report concerning sialolithiasis in an accessory parotid gland. The calculus was removed without facial nerve injury or salivary fistula via a peroral approach.

Surgical Outcomes for Rhinogenic Contact Point Headaches

Objective: To evaluate the surgical outcome in patients diagnosed as having rhinogenic contact point headaches (RCPH). Subjects and Methods: Thirty-six patients (aged 17–58 years) with RCPH underwent mini functional endoscopic sinus surgery procedures. Patients’ pain complaints were evaluated with a visual analog scale (VAS) both pre- and postoperatively. Results: All patients reported a decrease in the intensity of pain postoperatively. Nineteen patients (52.7%) reported complete relief. The difference between the preoperative (mean 8.62) and postoperative VAS pain scores (mean 2.11) was statistically very significant (p = 0.0000). No major complications were encountered. Conclusion: The removal of contact points in patients with RCPH is very effective in carefully selected patients.

Noise-induced hearing loss in mice treated with antiretroviral drugs

The results reported here for CBA/CaJ mice describe the effects of regular dosing with a common antiretroviral drug combination on outer hair cell (OHC) function using measures of 2f1-f2 distortion product otoacoustic emissions (DPOAEs) and auditory brainstem responses (ABRs). Specifically, experimental mice were treated daily over a 3-mo period with the nucleoside reverse transcriptase inhibitors (NRTIs), zidovudine (ZDV) and lamivudine (3TC), dissolved in their drinking water, while their control counterparts received untreated water. DPOAE levels and ABR detection thresholds prior to and after 12 wk of NRTI treatment did not differ between experimental and control groups. To assess whether NRTI treatment potentiates the adverse effects of noise over-exposure on OHC function, both experimental and control mice were exposed 1 wk later, while still on the drug regimen, to a 10-kHz octave-band noise (OBN) at 105-dB SPL for 1h. A major outcome of the sound over-exposure episode was that the NRTI-pretreated mice showed significantly greater permanent OBN-induced reductions in DPOAE levels at 2 wk postexposure than were observed for the untreated control animals. These findings support the notion that a synergistic relationship exists between certain NRTIs and intense sounds in that such preexposure drug treatments produced greater noise-induced decreases in DPOAE activity than did noise exposure alone. This drug/noise interaction is consistent with the known harmful effects of NRTIs on cellular mitochondrial activity.

Sialoblastoma in the parotid gland: a case report.

Salivary gland tumors that are originated from ductal epithelial cells are seldom seen in children younger than 2 years of age. Sialoblastoma is a rare salivary gland tumor that appears at birth or during the perinatal term. It consists of basaloid epithelial and stromal parts in various amounts. It was first reported by Vawter and Tefft as embryoma in 1966. Taylor suggested the sialoblastoma term. This tumor is also known as congenital basal cell adenoma, basal cell adenoma, basaloid adenocarcinoma, or embryoma. Although approximately 30 cases have been reported in the literature, the number of actual cases might be higher because of similar congenital basaloid tumors. Sialoblastoma is usually placed in parotid glands, but it has also been reported in submandibular glands in a few cases. A case that was placed in the ectopic salivary gland was also reported. We report a sialoblastoma next to the right parotid gland in a 4-year-old boy.

Nasal obstruction may alleviate bruxism related temporomandibular joint disorders

Temporomandibular disorder (TMD) is a collective term used to identify a group of musculoskeletal conditions of the temporomandibular region. Bruxism is a non-functional activity characterized by repeated tooth clenching or grinding in an unconscious manner. Over the time bruxism may lead to TMD by the uploading it causes. Nasal obstruction is a common complaint that necessitates mouth breathing when severe. The treatment of bruxism is frequently performed by oral appliances, which induce occlusal disengagement and relax jaw musculature and therefore reduce the force on the temporomandibular joint (TMJ). We believe that nasal obstruction may indirectly have a preemptive and therapeutic effect on sleep bruxism related TMD by causing mouth breathing.

Non-pulsatile subjective tinnitus without hearing loss may be caused by undetectable sounds originating from venous system of the brain

Tinnitus is a common otologic symptom, which can interfere with the daily activities of life. Subjective tinnitus is perception of sound only heard by the patient. The most common type of tinnitus is non-pulsatile subjective tinnitus (NST), which is believed to originate from auditory pathway, mostly from central nervous system. This hypothesis proposes that an important percentage of NST cases are actually misdiagnosed venous type tinnitus cases. Recent studies have demonstrated that dural-jugular system is dominant only in the horizontal body position. Jugular flow is at maximum during this position possibly making any noise generated within the dural-jugular system louder. As body assumes more vertical positions it gradually leaves its function to the extrajugular venous system of the brain. When there is an objective and/or a pulsating sound it is easier to suspect a vascular etiology and diagnose it clinically or radiologically. However, if a vascular pathology causes a non-pulsatile complaint that can not be heard by the examiner or can not be detected clinically or radiologically, it is bound to be misdiagnosed as central tinnitus. Most NST cases experience their symptoms especially at night. Night time usually allows the combination of silent ambience and horizontal body position to take place. We believe that in some NST cases, especially those without hearing loss (HL), the main cause of tinnitus is venous in origin.