Hasan Yasan

Removal of a laryngeal leech: A safe and effective method.

This article presents a case of hoarseness, dysphagia, and hemoptysis caused by the laryngeal localization of a leech. This pathological condition is extremely rare in urban areas but is frequent in endemic rural areas. Laryngoscopic evaluation of our patient has shown a leech lodged on the left arytenoid region hanging down to larynx. We present a patient living in an urban area with laryngeal leech that was removed under general induction anesthesia of sevoflurane via a face mask without endotracheal intubation.

What Is the Relationship Between Chronic Sinus Disease and Isolated Nasal Septal Deviation

Objective The aim of this retrospective study is to examine the role of isolated nasal septal deviation (NSD) in the pathogenesis of chronic rhinosinusitis (CRS). Study Design and Setting The interaction between isolated NSD and chronic sinus disease were retrospectively evaluated in 1452 patients. Out of 1452 patients, 152 patients were included in the study. Patients with anatomical variants other than NSD were excluded from the study. Patients with NSD were enrolled in the study group and patients without NSD were enrolled in the control group. Results There was no statistically significant difference between NSD group and non-NSD group with respect to the CRS. Conclusions The mild to moderate degree of NSD was not a risk factor for chronic sinus disease. Only gross deviation of the nasal septum itself is a risk factor for the development of CRS. Significance Excluding the subjects with ostiomeatal anatomic variations has differentiated this study from the previously reported researches (isolated NSD).

Congenital vomeral bone defect in two thalassemia trait cases

The nasal septum is composed of a perpendicular plate of ethmoid bone, quadrilateral septal cartilage, membraneous septum, crest of palatine and maxillary bone and vomer. Defects of the nasal septum may be due to a variety of causes such as trauma, infection, inhalant irritants and neoplasia. To our knowledge, up until now, congenital defect of the vomer has been presented in six cases without any nasal symptoms. We present two cases of congenital defect of vomer with thalassemia trait, the patients complaining of nasal obstruction.

Otitis media with effusion and histopathologic properties of adenoid tissue

OBJECTIVE Adenoidectomy is being generally used for the treatment of otitis media with effusion (OME). The purpose of current study was to determine objectively the significance of the histopathology of adenoid tissue on the development of otitis media with effusion. METHODS The records of all the patients operated on with the diagnosis of adenoid enlargement with or without OME were reviewed and pathologic specimen were re-evaluated regarding histopathological properties by one pathologist unfamiliar with the diagnosis. Sixty-one patients with adenoid hyperplasia were enrolled in the study group, 38 males and 23 females. Age ranged between 3 and 13 years (mean age was 7.03+/-3.26 years). All the patients of study group were those operated on due to the adenoid hyperplasia and uni- or bilateral OME. Control group was composed of 39 male and 26 female patients (age range was between 3 and 13 years, and mean age was 7.06+/-3.04 years) with solely adenoid hyperplasia. RESULTS The squamous metaplasia was present in 47 (77%) and 14 (22%) patients of study and control groups, respectively. The fibrosis of connective tissue interspersed follicles of adenoid was present in 29 (48%) and 6 (9%) patients of study and control groups, respectively. The statistical analysis revealed a significant prevalence of squamous metaplasia (P<0.001) and fibrosis of connective tissue interspersed follicles of adenoid (P<0.001) for a surgical indication of adenoid hyperplasia with OME than for without OME. The prevalence of other parameters was not significantly different between two groups. CONCLUSIONS Adenoid tissue not only exerts an obstructive influence on the eustachian tube lumen when enlarged, but also impedes (hinders) mucociliary drainage of the middle ear by the way of non-ciliated metaplastic epithelium and fibrosis of connective tissue.

Polymorphic variants of MnSOD Val16Ala, CAT-262 C < T and GPx1 Pro198Leu genotypes and the risk of laryngeal cancer in a smoking population

OBJECTIVE To investigate the relationship between development of laryngeal cancer and the presence of polymorphisms of the MnSOD Val16Ala, CAT-262 C < T and GPx1 Pro198Leu genes in a smoking population. PATIENTS AND METHODS Single nucleotide polymorphisms were determined in DNA from the peripheral blood erythrocytes of 48 heavy smokers (25 patients with laryngeal cancer and 23 cancer-free controls), using polymerase chain reaction. RESULTS There were no significant differences in age, smoking duration or smoking intensity, comparing the two groups. The homozygous AA genotype of MnSOD Val16Ala was significantly more prevalent in the cancer group than the control group (92 vs 13 per cent, respectively), while the heterozygous AV genotype of MnSOD Val16Ala was more prevalent in the control group than the cancer group (87 vs 8 per cent, respectively) (p < 0.001). There were no significant differences between the cancer and control groups regarding GPx1 Pro198Leu or CAT-262 C < T polymorphisms. CONCLUSION Polymorphism of the MnSOD Val16Ala gene may contribute to susceptibility to laryngeal cancer among smokers.

The effect of topical corticosteroid on basic fibroblast growth factor in nasal polyp tissue.

Background The etiology of nasal polyposis and pathophysiological mechanisms of polyp formation is still poorly understood. Experimental models have suggested that nasal polyp growth requires extracellular matrix formation and is associated with fibroblast proliferation. Intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. Basic fibroblast growth factor (bFGF) is a potent angiogenesis factor and is mitogenic for a wide range of cell types. We investigated the alteration of bFGF levels in nasal polyp tissue after administration of topical corticosteroid. Methods Nasal polyp tissues were obtained from 36 patients with diffuse nasal polyposis before and after topical nasal steroid treatment. As a topical nasal steroid mometasone furoate was given for 4 weeks in a dosage of 200 μg/day. The bFGF levels were measured by competitive enzyme immunoassay method. Results The mean levels of tissue bFGF, before and after topical nasal steroid treatment, were 1485 ± 826 ng/mg protein (range, 416–3434 ng/mg) and 1340 ± 749 ng/mg protein (range, 330–3288 ng/mg), respectively. The levels of bFGF in nasal polyps were significantly lower than those before treatment after administration of topical nasal steroid (p = 0.011). Conclusion Administration of topical nasal steroid decreases bFGF levels of nasal polyp. It may be suggested that one of the effects in diminishing the size of nasal polyps is by decreasing the bFGF.

Persistent hoarseness in a patient with pachyonychia congenita: an early sign of laryngeal involvement

A 13-month-old boy, born of a nonconsanguineous marriage, presented with extensor hyperkeratotic papules and subungual hyperkeratosis with yellow–brown discoloration of the nail plate affecting all 20 nails, developing within the first few months of life. Whitish plaques were also observed on the oral mucosa. His mother reported progressive hoarseness, especially on crying. Treatment for onychomycosis and oral candidiasis for 2 months yielded no improvement. Multiple courses of antimicrobials for presumed upper respiratory tract infection did not improve the hoarseness. There were no other known medical problems, and his growth and development were within the normal range. Natal teeth, hair abnormalities, and abnormal dentition were not found. The family history regarding other ectodermal disorders was noncontributory. On physical examination, there was subungual hyperkeratosis and yellow–brown discoloration of all the nails (Fig. 1), symmetric follicular hyperkeratotic papules on the extensor surface of the knees and elbows, and palmar blisters. Intraoral examination showed irregularly shaped whitish plaques on the dorsal tongue, palate, buccal mucosa, and both sides of the labial commissure, together with angular cheilitis (Fig. 2). Sweating was normal. A complete ophthalmologic examination (including pupil dilation) showed normal results. Potassium hydroxide (KOH) examination and fungal culture of scrapings of the nail and from the whitish mucosal plaques yielded negative findings. Laryngeal examination under general anesthesia using an endoscopic video information system revealed a slightly elevated, white, hyperkeratotic plaque of 3–4 mm in diameter that extended from the posterior commissure to the anterior interarytenoid mucosa, and two small whitish clear papules, measuring 1–2 mm in diameter, on the upper part of the left vocal cord (Fig. 3). There was no history of any problems with respiratoryobstruction. The boy was otherwisegenerally healthy with unremarkable findings on systematic examination. The results of laboratory investigation, including 1346 Figure 1 Clinical appearance of hypertrophic nail dystrophy and discoloration of the toenails

The effects of methylprednisolone, montelukast and indomethacine in experimental otitis media with effusion

OBJECTIVES The present study aimed to investigate the effects of indomethacine, montelukast and methylprednisolone in management of experimental otitis media with effusion. METHODS Forty Wistar albino rats of which the weights ranged between 310 and 370 g were included in this study. Middle ear effusion was created by transtympanic histamine injection. The presence of effusion was confirmed by otomicroscopic examination. Thirty-seven rats with effusion were divided into 4 groups (methylprednisolone, montelukast, indomethacine and saline-control groups). All agents were administered for a period of consecutive 10 days. At the 11th days of administration, the recovery of effusion was confirmed by otomicroscopic examination. Tympanic bullae of the rats were removed and histopathological examinations were carried out. In the histopathological examination, the neutrophil leukocytes accumulated in the middle ear submucosa were counted. RESULTS The mean numbers of submucosal neutrophils in the methylprednisolone, montelukast, indomethacine, and saline groups were 24.6±8.1, 54.1±6.2, 52.3±7.3, 55.7±8.3, respectively. The otomicroscopic recovery rates of effusion in the methylprednisolone, montelukast, indomethacine, and saline groups were 18/18 (100%), 8/18 (44%), 2/14 (14%), 2/18 (11%) respectively. CONCLUSIONS Methylprednisolone and montelukast ameliorate the middle ear effusion. However, only methylprednisolone reduces the submucosal infiltration of the neutrophil leukocytes which are the most evident cell of inflammatory process. Montelukast is effective in the resolution of experimental otitis media with effusion.

Incus and stapes necrosis associated with diabetes mellitus.

Chronic otitis media is often associated with ossicular defects, the most frequent being necrosis of the long process of incus. Except for infection and cholesteatoma; trauma and local pressure by chorda tympani are uncommon causes leading to incus erosion. In the literature, no case of incus necrosis has been reported associated with type II diabetes mellitus (DM). A patient is presented in this report with incus and stapes suprastructure necrosis and associated type II DM who was admitted to the out-patient clinic with complaints of conductive hearing loss.

The effects of tympanic membrane perforation on bone conduction hearing level.

OBJECTIVE To assess the effects of pure tympanic membrane perforation on bone conduction hearing level. PATIENTS AND METHODS Fifty-six ears of 52 consecutive patients with dry perforated tympanic membrane, and without any middle and/or inner ear pathology were involved in this retrospective study. Of these 52 patients 23 (44.2%) were male and 29 (55.8%) were female. Mean age and age range were 32.01±12.73 and 10-49 years, respectively. Bone conduction thresholds before and after the paper patch manipulation were recorded at the same day. Two measurements were compared to find out the effect of perforated tympanic membrane on the bone conduction hearing level. RESULTS There were statistically significant differences between pre and post-paper patch values of bone conduction thresholds at 0.5, 1, 2 and 4kHz frequencies (P=0.001, 0.001, 0.001 and 0.01, respectively). CONCLUSIONS Pure tympanic membrane perforation increases bone conduction thresholds. The exact mechanism that deteriorates the bone conduction hearing level in patients with pure dry perforated tympanic membrane needs further studies.