Hakan Çankaya

Changes in serum IGF-1 and IGFBP-3 levels and growth in children following adenoidectomy, tonsillectomy or adenotonsillectomy

OBJECTIVE The aim of this study is to determine the effect of adenoidectomy, tonsillectomy or adenotonsillectomy on growth. For this purpose, we prospectively reviewed the postoperative changes in serum levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3), weight and height in children that underwent adenoidectomy, tonsillectomy or adenotonsillectomy. METHODS Ninety-six children with symptoms of sleep disordered breathing (SDB) or recurrent adenotonsillitis were enrolled to study. Blood samples were taken preoperatively and repeated at 6 months following operation to determine the changes in serum IGF-1 and IGFBP-3 levels, pre- and postoperative values of weight and height were recorded for each operation. RESULTS Thirty-six patients underwent adenoidectomy, 52 patients underwent adenotonsillectomy and 8 patients underwent tonsillectomy. Seventy of the operations were performed for SDB and 26 were performed for recurrent adenotonsillitis. The mean serum levels of IGF-1 increased by 26%, from 126.74+/-112.13 ng/ml to 159.82+/-122.91 ng/ml (p<0.001) and IGFBP-3 levels increased by 7%, from 3.34+/-1.17 microg/l to 3.57+/-1.16 microg/l (p<0.05) 6 months after operation. The increase was independent from the preoperative diagnosis. There was a significant increase both in patients with SDB and in children with recurrent infections (p<0.001 for IGF-1, p<0.05 for IGFBP-3). Their Z scores (standard deviation scores) for body weights (mean Z score from -0.06+/-0.98 to 0.118+/-1.18, p<0.001) and heights (mean Z score from 0.30+/-0.98 to 0.42+/-0.88, p<0.001) were significantly higher 6 months after the operation compared to preoperative period. CONCLUSIONS We found a significant increase in weight, height, and IGF-1 and IGFBP-3 levels of children with SDB or recurrent infections postoperatively. These results suggest that upper airway obstruction may not be the only mechanism that causes retardation on growth in children.

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.

Prevalence and risk factors of otitis media with effusion in school children in Eastern Anatolia

OBJECTIVE To investigate the prevalence and demographic, environmental and child associated risk factors of OME in schoolchildren in Eastern Anatolia, Turkey, and analyze the results with reference to the review of the literature. METHODS A total of 2355 children who were attending two different primary schools, one located in low, and the other located in a high socioeconomic district of city of Van were screened and 2320 children who met the inclusion criteria were enrolled to study. Standardized questionnaires that include nine questions for determination of risk factors were delivered to the parents to be filled before examination of each child. All of the children underwent both otoscopic examination and tympanometric evaluation to provide high accuracy on the diagnosis of OME. The association between children diagnosed as OME and the answers to the questionnaires were evaluated. Also, teachers of the children were asked to complete a questionnaire evaluating childs level of school success, and the success levels of children with or without OME were compared. RESULTS The prevalence of OME was found to be 10.43%. Second-hand smoking (p<0.0001), low socioeconomic status (p<0.001), living in a crowded house (p<0.001), presence of atopy (p<0.01), lack of breast-feeding (p<0.05), presence of URTI (p<0.0001), young age (p<0.001) and snoring (p<0.0001) were found to be associated with prevalence of OME. No significance was found for duration of breast-feeding, gender, birth history and previous otolaryngological operations. Also, children with OME were tended to be less successful in terms of school success. CONCLUSIONS The potential of OME to cause serious sequelae and complications that may affect childrens life long-term, makes the disease an important health problem. Environmental, epidemiologic and familial factors play an important role in pathogenesis of OME. Caretakers must be informed about these highly modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.

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.

Evaluation and treatment of antrochoanal polyps

OBJECTIVES Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through a sinus ostium, and extends into the choana. The common presentation of ACP is unilateral nasal obstruction. The radiographic findings and differential diagnosis of ACPs are discussed by comparing them with data in the literature. METHOD This study included 19 (14 male, 5 female; median age 24.5 years, range 8-75 years) surgically treated patients with ACPs diagnosed by clinical examination, nasal endoscopy, and computed tomography. RESULTS Nasal obstruction was found in all cases. Endoscopic sinus surgery was preferred for removal of the nasal part of ACPs in 13 cases. Only in one case, polypectomy combined with Caldwell-Luc operation and septoplasty was performed. The observed complications were as follows: minor hemorrhage in three cases, mild cheek swelling with pain in two patients, and infraorbital hypoesthesia in one case. Histopathologic examination of ACPs revealed loose mucoid stroma and mucous glands, which were covered by respiratory epithelium. CONCLUSION Endoscopic sinus surgery may be indicated in patients with ACPs because the function and capacity of the maxillary antrum are preserved. The greater portion of the antral part of polyp can be removed while leaving the healthy antral mucosa intact.

Report of an Infant with Noma (Cancrum Oris)

Noma (cancrum oris) is an infectious disease that destroys the oro‐facial tissues and other neighboring structures in its fulminating course. The starting point of the disease is acute ulcero‐necrotic gingivitis, which results in an extensive gangrenous plaque destroying all of the soft tissues of the face. It predominantly affects children aged 2–16 years and is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene, as in developing countries. We discuss possible predisposing factors in cancrum oris such as malnutrition, infectious diseases, HIV infection, and immune compromise conditions. Poverty is the most important risk factor. We report the case of a 6‐month‐old child with noma and review the characteristic features of this disease.

Retrospective analysis of our cases with sudden hearing loss.

OBJECTIVE To determine the prognostic factors and healing ranges of patients treated for sudden hearing loss (SHL). PATIENTS AND METHODS In our study, 33 patients treated for SHL were evaluated between March 1995 and October 2001 retrospectively. After the routine examinations, first audiograms were done. The audiograms were classified as hearing loss in low frequencies, high frequencies, and flat using the Shey and Rubin classification systems. All patients were treated with the same standard regimen. The benefits of treatment were evaluated with the Siegel classification. RESULTS Various amounts of hearing gains were obtained in 17 of 21 patients treated in the first 5 days. No gain was obtained in 5 of 12 patients, who re-presented after the first 5 days of SHL. There was a statistically significant difference between the two groups (p =.005). There was hearing gain in all nine patients who had upward-sloping type of audiograms. Hearing gain was obtained in 8 of 12 downward-sloping type and 7 of 12 flat-type audiograms. There was a significant difference between the raising type group and the other groups (p =.04 and p =.014). Also, in 6 of 14 patients with vertigo and in 4 of 12 with bilateral sensorineural hearing loss (SNHL), there was no gain. CONCLUSION The prognosis of SHL is found to be better in patients who present early and mild SNHL and unilateral cases and worse in vertigo, bilaterally severe SNHL, and childhood.

Effects of topical chlorhexidine applied to the rabbit nasal mucosa.

OBJECTIVE To search the effects of administration of various concentrations of a wide-spectrum antimicrobial agent, chlorhexidine, to the nasal mucosa. MATERIAL AND METHODS About 0.20, 0.12, 0.06 and 0.03% concentrations of chlorhexidine gluconate were applied to the rabbit nasal mucosa as one puff twice a day throughout 5 days. Another group, treated with serum saline to the nose, behaved as the control group. On the fifth day following drug administration, specimens were taken from nasal mucosa of the rabbits and examined under light microscope. RESULTS As a result of comparison between drug treated group and control group, with increasing drug concentrations progressively increased neutrophil infiltration in mucosa, ciliary loss in cells, and occasional metaplasia were observed. CONCLUSION There is a linear, positive and strong association between concentrations of chlorhexidine and its irritative effects on rabbit nasal mucosa. While 0.20 and 0.12% concentrations of chlorhexidine cause excess irritation on the nasal cavity, 0.06 and 0.03% concentrations of chlorhexidine gluconate causes lower irritation and effects on the animals which have experimentally induced rhinosinusitis must be evaluated.

Nasopharyngeal rhabdomyosarcoma in a patient with hypohidrotic ectodermal dysplasia syndrome

Hypohidrotic ectodermal dysplasia (Christ-Siemens-Touraine syndrome) is characterized by partial or complete absence of sweat glands, hypotrichosis, hypodontia, prominent frontal ridges and chin, saddle nose, sunken cheeks, thick, everted lips, large ears and sparse hair. While association of other ectodermal dysplasia syndromes with tumors such a non-Hodgkins lymphoma, hamartoma, keratoakanthoma, Merkel-cell cancer, squamous-cell carcinoma, syringofibroadenomatosis has been reported, association of hypohidrotic ectodermal dysplasia and a tumor has not been reported. In a five-year-old male patient admitted with nasal obstruction and nasal mass complaints, we have reported firstly an association of hypohidrotic ectodermal dysplasia and nasopharyngeal rhabdomyosarcoma.

Effect of inhaled steroids on laryngeal microflora

Abstract Conclusions As is known, this study is the first study to evaluate the effect of inhaled steroids on laryngeal microflora. The data support that ICS usage causes changes in the larynx microflora. Purpose The aim of this study was to determine the alteration in larynx microbial flora of the patients treated with ICS comparing the culture results of a control group. In addition, laryngeal microflora was compared to the smears obtained from the vallecula and pharynx. Materials and methods The study included 39 patients (mean age = 45.56 ± 12.76 years) who had been using a corticosteroid inhaler and control group consisting of 27 persons (mean age = 43.07 ± 13.23 years). Culture samples were obtained from the pharynx, larynx, and vallecula in the patient and control groups, and they were evaluated in the microbiology laboratory. Obtained culture results were named by the same microbiologist according to the basic microorganism classification method. Results Coagulase-negative staphylococci (CNS), Streptococcus viridians (VGS) and candida albicans were detected to grow significantly more in the patient group in all three anatomic localizations compared to the control group. Neisseria spp, basillus spp, and Non-viridans alpha-hemolytic streptococcus were detected to grow significantly more in the control group in all three anatomic localizations compared to the patient group.