Erol Egeli

Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery

Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Hallers cells) in 6%, spheno-ethmoid cells (Onodis cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.

Evaluation of the inferior turbinate in patients with deviated nasal septum by using computed tomography.

Objectives/Hypothesis The objective was to measure the dimensions, composition, and possible structural and radiological changes of the compensatory hypertrophic inferior turbinate in patients with deviated nasal septum.

Schwannoma of the tongue in a child

Schwannomas are tumors of the peripheral nerves originating in the nerve sheaths that account for 1% of benign tumors located in the oral cavity. The tongue as a whole is the most common location for intraoral schwannomas to occur; however, it is quite rare to diagnose schwannoma in children. We are contributing a report of a 13-year-old child with a 1-year history of slowly growing swelling on the anterior part of corpus of the tongue. The patient complained of the disturbance to mastication and phonation. Diagnosis was confirmed by excisional biopsy. Histologic identification of Antoni A and B areas along with strong and diffuse staining with S-100 stain pathologically completed the diagnosis of schwannoma.

Auditory brainstem response in children with iron deficiency anemia.

To investigate the neurosensorial influences with auditory brainstem response (ABR) in iron deficiency anemia. We recorded ABR in 33 children with iron deficiency anemia followed and in 31 healthy children (control group 1, 0-12 months, control group 2, 13-36 months, control group 3, 37-60 months) as a control group. The patients and controls were divided into three group: group I, at 12 months of age, group II, 13-36 months, and group III, 37-60 months. In all groups, composed latency time, inter-peak latency, amplitude of peaks, I-V wave amplitude ratio and waveform were evaluated and compared with control groups. In group I, I-V interpeak latency was increased compared with control group I (4.58 vs. 4.20 ms, p < 0.05). In group II, Wave V latency time and III-V interpeak latency were increased compared with control group 2 (6.21 ms vs. 5.63 ms. p < 0.005 and 0, 48 vs. 0.22 p < 0.005, respectively). In group III, wave I latency time was increased compared with control group 3 (1.56 ms vs. 1.46 ms) (p < 0.05). We considered that increases in ABR latencies might be explained by delayed maturation of myelinisation, which requires iron, and/or by dysfunction of iron containing enzymes.

Investigation of gastric pepsinogen in middle ear fluid of children with glue ear

Abstract Conclusion: The presence of pepsinogen in middle ear effusion (MEE) supports the relationship between gastroesophageal reflux (GER) and otitis media with effusion (OME). Measurement of pepsin/pepsinogen can be considered as a simple and reliable method for assesment of reflux in children. However, further research is needed to establish a definite association between GER and OME before beginning antireflux treatment in the management of MEE. Objective: The aim of this study was to investigate the relationship between GER and chronic OME, and to confirm the presence of gastric enzyme in the MEE of children with OME. Methods: This was a prospective study. MEE and blood samples were obtained from 42 children undergoing tympanostomy tube placement. Total pepsinogen concentrations of effusions and serum samples were measured with a commercial ELISA using a human pepsinogen I specific antibody. Albumin levels of effusions and serum samples were also measured with ELISA for comparison with pepsinogen levels. Results: Measurable pepsinogen was present in all MEEs from patients, with levels higher than the serum values. The difference between the levels of pepsinogen measured in MEE and serum was statistically significant (p < 0.01), but albumin levels were higher in serum than in MEE and the difference was statistically significant (p < 0.01).

Unilateral Sinonasal Symptoms

Objective: The aim of the study was to describe the pathology in patients with unilateral sinonasal symptoms and to identify variables that may predict neoplastic pathology. Study Design: Retrospective chart review. Methods: A retrospective analysis was completed on 207 consecutive patients with sinonasal symptoms, most of whom underwent functional endoscopic sinus surgery from 2005 to 2008. Of the charts reviewed, 63 patients had unilateral sinonasal symptoms with unilateral opacification of paranasal sinus computed tomography scans. Presenting symptoms and radiographic, surgical, and pathologic findings were analyzed. Results: All 63 patients underwent surgical management for their symptoms, and specimens were sent for pathologic evaluation. There were 12 cases of antrochoanal polyp, 14 of nasal polyposis, 8 of chronic rhinosinusitis, 7 of concha bullosa, 4 of retention cyst in maxillary sinus, 2 of mucocele, 3 of oroantral originated cyst, and 13 cases of benign or malign neoplastic diseases, some of which were extremely rare cases such as pleomorphic adenoma, ameloblastoma, schwannoma, myxoma, and non-Hodgkin lymphoma. Nasal discharge was more common in inflammatory than neoplastic disease. However, epistaxis was more common in neoplastic disease. Conclusions: A wide variety of pathologic findings present with unilateral sinonasal symptoms. A careful history, examination, and radiographic studies can often determine the responsible disease process. Histologic confirmation remains obligatory for diagnosis. There are also some rare cases, which should be considered in differential diagnosis of unilateral polyp or mass lesion on nasoendoscopy.

The effect of peritonsillar corticosteroid infiltration in tonsillectomy

A prospective, randomized, double-blind, placebo-control clinical study was performed to determine the effects of peritonsillar infiltration of dexamethasone on peroperative and postoperative morbidity in patients undergoing tonsillectomy with local anesthesia. A total of fifty-two patients, aged 14-34, were randomized to infiltrate dexamethasone (0.5 mg/kg, maximum dose, 12 mg) or placebo with local anesthetic at the peritonsillar region. Incidence of postoperative complications, pain medications, appetite, oral intake (type of diet) and fever were also compared between the two groups. Demographics of dexamethasone and placebo groups were similar. No statistically significant differences were noted peroperative procedures, postoperative complications, pain medication, appetite, oral intake (type of diet) between the two groups of patients.

Do patients with sclerotic mastoids require aeration to improve success of tympanoplasty

Abstract Conclusion: We could not find any significant difference in the results for graft success rate and functional hearing results between the myringoplasty and tympano-mastoidectomy groups. So mastoidectomy may not be necessary for successful tympanic membrane reconstruction and hearing improvement. Objective: To investigate the effect of aerating mastoidectomy on the surgical success rate of myringoplasty. Methods: This was a retrospective study. Data were analyzed from 92 patients who underwent surgical repair of tympanic membrane perforations due to chronic suppurative otitis media (CSOM) without cholesteatoma. Tympano-mastoidectomy was performed in 46 patients with a small sclerotic mastoid. The other 46 patients underwent myringoplasty without mastoidectomy. Patients were evaluated for success in tympanic membrane reconstruction and hearing levels after a minimum follow-up duration of 1 year. Results: Tympanic membrane perforation closure was successful in 76.1% (n = 35) of the 46 patients undergoing myringoplasty and in 78.3% (n = 36) of the 46 patients undergoing myringoplasty with mastoidectomy. The difference between the closure rates of the two groups was not statistically significant (p > 0.05). The difference between the two groups for hearing gain was also not statistically significant (p > 0.05).

Laryngeal amyloidosis. A rare cause of laryngocele

Laryngocele may be defined as an abnormal dilatation of the saccule of the ventricle and its pathogenesis is uncertain. We report a laryngocele caused by amyloidosis localized to larynx in a 60-year-old male patient. We would like to mention that amyloidosis should be evaluated in the etiology of patients diagnosed as having a laryngocele.

Does reflux have an effect on nasal mucociliary transport

Abstract Conclusion: Gastroesophageal and laryngopharyngeal reflux were found to have no effect on nasal mucociliary transport. Objective: Gastroesophageal and laryngopharyngeal reflux have been recognized as causative factors for chronic rhinosinusitis but no definite mechanism has been described yet. We aimed to determine whether gastroesophageal and laryngopharyngeal reflux impair nasal mucociliary transport. Methods: This was a prospective cohort study in a tertiary referral center. Fifty patients with both laryngopharyngeal and gastroesophageal reflux comprised the study group. Reflux syndrome index and reflux finding score were calculated for each patient before and after treatment. Antireflux medication was given for 12 weeks. The control group consisted of 30 healthy volunteers. Nasal mucociliary transport was assessed by means of the saccharine test. It was performed before and after the treatment. Statistical analysis was performed using the saccharine test results of the study and control groups. Results: No statistical difference was found between the saccharine test results of the study group and control group before treatment. The differences betweeen the pretreatment and post-treatment reflux symptom index and reflux finding scores were statistically significant. The difference between the post-treatment saccharine test results of the patients in whom reflux scores returned to normal and those with remaining high scores was not statistically significant.