Irfan Yorulmaz

Is laryngopharyngeal reflux an important risk factor in the development of laryngeal carcinoma

Laryngopharyngeal reflux (LPR) as a causative irritating factor in the development of laryngeal carcinoma has been suggested. However, the association between LPR and laryngeal carcinoma remains unclear. The aim of this study was to compare the prevalence and severity of reflux between patients with laryngeal carcinoma and clinical LPR. The intention was to find out if a correlation exists between the laryngeal findings and the level of acid reflux. The study population consisted of 29 patients with laryngeal cancer (group I), 33 LPR patients with normal laryngeal findings (group II) and 70 LPR patients with related laryngeal pathology (group III). The results of 24-h, double-channel ambulatory esophageal pH monitoring were analyzed comparing the three groups. The occurrence and severity of abnormal acid reflux at the upper and lower esophageal segments were evaluated. The incidence of LPR or gastroesophageal reflux (GER) did not vary in any of the three groups (LPR was present in 62, 42 and 56% of the patients, while GER was present in 45, 24 and 37% of the patients, respectively). Patients with LPR or GER from the three groups did not differ significantly in terms of the number of acid reflux episodes and percentage of times when the pH was <4. Our data do not support the hypothesis that LPR can be an independent risk factor in the development of larynx cancers. However, the data also do not thoroughly exclude the possibility. The reason why LPR leads to variable pathologies in the larynx may be uncovered by studies probing the differences between patients via detailed examinations of the local anti-reflux barriers such as epithelial morphology and functions.

Fat graft myringoplasty: a cost-effective but underused procedure

OBJECTIVES The objective of this study was to evaluate the success of fat graft myringoplasty and to discuss the utilities and advantages of a fat graft in primary versus revision myringoplasties. METHODS Eighteen patients who had not had previous otological surgery, and twelve patients whose tympanic membrane perforations have persisted despite myringoplasty with temporalis fascia were included in this prospective clinical trial. All patients were treated by fat graft myringoplasty and followed up for one year. RESULTS Successful closure of the perforation was obtained in 82.4 per cent of the ears at the final follow up. The success rate in the group of patients who had not had previous otological surgery was higher than those of revision cases. CONCLUSIONS Adipose tissue provides the basic requirements for grafting of the tympanic membrane, with its own favourable characteristics. Fat graft myringoplasty is a cost-effective alternative in small perforations of the tympanic membrane, including revision cases.

Gastroesophageal Reflux Disease: Symptoms Versus pH Monitoring Results

OBJECTIVES The reason why some patients with gastroesophageal reflux disease (GERD) have symptoms of upper aerodigestive system irritation, while others mainly have gastroenterologic symptoms, is not well established. This retrospective case series study was designed to examine the existence of a correlation between symptoms and reflux characteristics, based on data obtained from esophageal pH monitoring. METHODS The study population consisted of 139 patients; 97 patients presented with laryngopharyngeal symptoms of GERD, including unexplained hoarseness, throat clearing, chronic cough, laryngospasm, globus, throat pain, and 42 patients presented with gastroenterologic symptoms, including heartburn and regurgitation. The results of 24-hour, double-channel ambulatory esophageal pH monitoring were analyzed comparing 2 symptom groups. The incidence of abnormal acid reflux at the upper and lower esophageal segments and the effects of upright and supine positions on reflux parameters were evaluated. RESULTS The incidence of laryngopharyngeal reflux was significantly higher in the laryngopharyngeal symptom group than in the other (52% versus 38%). The patients with laryngopharyngeal reflux from both groups showed no significant differences in terms of number of acid reflux episodes, percentage of times pH was 4, and esophageal acid clearance. Upright and supine parameters did not show significant differences between the patient groups. Upright acid reflux episodes were, however, common in both groups at the lower esophageal and laryngopharyngeal segments. CONCLUSION Recent studies suggesting that otolaryngologic patients commonly show upright, daytime reflux with normal esophageal clearance and that typical GERD patients commonly have supine, nocturnal reflux with prolonged esophageal clearance are not supported by this study. This study indicates that acid reflux parameters and positional changes are not sufficient to explain why patients with GERD experience different symptoms. The regional symptoms of GERD may be attributed to the impairment of epithelial resistance, motor activity, and buffering systems for the esophageal antireflux barrier.

Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux

BACKGROUND The most common tool for the diagnosis of laryngopharyngeal reflux (LPR) is still 24-hours esophageal pH monitoring; there is lack of non-invasive, less expensive and accurate diagnostic tools for this frequent disease. AIMS To evaluate the accuracy of immunoserologic pepsin detection in the saliva for the diagnosis of LPR. STUDY DESIGN Cross-sectional study. METHODS A two channeled 24-hour esophageal pH monitoring catheter was placed in patients with a suspicion of LPR. During the 24-hour period, each patient gave one sample of sputum for the immunoserologic pepsin detection test. Pathologic gastroesophageal reflux (GER) findings, LPR findings, pH score in the proximal and distal probes when the sputum sample was given were recorded. The sensitivity, specificity, positive and negative predictive values of the pepsin detection test were analyzed and compared to pH monitoring scores. RESULTS The study group consisted of 20 patients who met the criteria. A positive pepsin detection test was elicited from 6 patients. The sensitivity and specificity of the pepsin detection test was 33% and 100%, respectively. A positive predictive value of 100% was recorded. When the pH results of the pepsin positive patients (PPP) and the rest of the study group in the proximal probe at the sample time were compared, the PPP had an apparent acidic pH value compared to the pepsin negative patients (pH: 3.26 for the PPP, pH: 6.81 for the pepsin negative patients). CONCLUSION Pepsin detection in the saliva is a recent method and becoming increasingly popular. Because of the benefits and ease of application, a positive salivary pepsin test in a patient suspected of having LPR can be a cost effective, accurate and alternative diagnostic method. Increasing the daily number of sputum samples may increase the sensitivity of the test.

Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall

PURPOSE The aim of the study was to attract attention to the surgical significance of unilateral agenesis of the frontal sinus hidden by the overlapping expansion of the contralateral sinus toward the agenetic side. MATERIALS AND METHODS Retrospective review of endoscopic transnasal sinus dissections of 55 human cadavers (42, formalin fixated; 13, fresh frozen) was done in a tertiary care academic medical center. Surgical and radiologic findings were noted. RESULTS Absence of right frontal sinus ostium in the presence of a connection between the right and left frontal sinuses was demonstrated in 2 (3.6%) cadavers. An absent and an incomplete septum between the frontal sinuses were also noted in these cadavers. No accompanying abnormality of other sinuses was found, and no evidence of previous sinus surgery was noted in these 2 cadavers. CONCLUSIONS If one of the frontal sinus ostia cannot be found during sinus surgery, although this sinus and its recess can be seen on the thick-sliced coronal computed tomographic (CT) scans, keep in mind that it may be (3.6%) an agenetic frontal sinus hidden by the extensive pneumatization of the contralateral sinus that is crossing the midline. It may not be possible to foresee this variant preoperatively by endoscopic examinations or thick-sliced CT scans. If there is suspicion, thin-sliced CT scans with reconstruction will be ideal to confirm the agenesis of the frontal sinus and to avoid complications. In the presence of such variant of frontal sinus, 1-sided successful frontal sinusotomy is adequate because this sinus or cell will already be drained through the treated frontal recess.

How Often Does Isolated Sphenoid Sinus Disease Turn Out to be a Neoplasm

AbstractIsolated sphenoid sinus disease (ISSD) describes a wide spectrum of pathologies including inflammatory, vascular, bony dysplastic, and neoplastic diseases. The aim of this study was to assess the frequency with which a neoplastic process was diagnosed in patients of ISSD and patient management strategies. A retrospective analysis was conducted for all ISSD patients who underwent surgery between January 2005 and January 2014 at a tertiary center. The clinical characteristics, radiologic studies, operative findings, endoscopic surgical techniques, pathology results, and treatment outcomes of the patients were analyzed. In all, 42 patients (31 women and 11 men) were included in the study. Histopathologic examinations revealed that 10 patients (23.4%) had neoplasms (8 benign and 2 malignant), 19 (45.2%) had mucocele, 7 (16.7%) had fungal disease, and 6 (14.3%) had meningoencephalocele and cerebrospinal fluid leakage. With the exception of 2 patients with plasmacytoma, complete removal of the lesions was achieved in all patients using transnasal or transethmoidal endoscopic approaches, and no local recurrences were observed during the mean follow-up period of 42 months. More than one fifth of the patients with ISSD were diagnosed with neoplasms. The results indicated that endonasal endoscopic approaches could effectively help manage patients with ISSD lesions, including those that were neoplastic. It is clear that precaution during preoperative planning is imperative to avoid unexpected situations and complications that may put surgeons in a difficult position during surgery.

Sarcomatoid carcinoma of the larynx: immunohistochemical analysis in two cases.

The great majority of cancers encountered in the upper respiratory tract and oral cavity are squamous cell carcinoma (SCC), with only infrequent examples of other histologic variants. Lane introduced the term pseudosarcoma to describe oropharyngeal and laryngeal tumors that he believed were non-neoplastic stromal responses to an adjacent epidermoid carcinoma. This rare tumor has occasionally been termed pseudosarcoma (PS), carcinosarcoma, spindle cell carcinoma, or sarcomatoid carcinoma (SC). The 3 theories of the histogenetic nature of the spindle cell (Sc) component are: (1) it is not neoplastic, (2) it is the mesenchymal metaplasia of SCC, and (3) it is a true sarcoma. Recent evidence supports the concept that this tumor is a pleomorphic variant of SCC and not a benign connective tissue response. SCs are problematic lesions for the clinician as well as the pathologist. In the following presentation, to further investigate the nature of the Sc component, we present 2 cases of PS of the larynx studied by immunohistochemistry with cytokeratins (CKs), vimentin (VIM), desmin, and smooth muscle actin (SMA).

Endonasal Endoscopic Management of Fibrous Dysplasia Involving Sphenoid Sinus and Optic Nerve: Postoperative Outcomes

Objective: To evaluate success of endonasal endoscopic surgery in removing fibrous dysplasia (FD) lesions involving sphenoid sinuses at areas close to important structures and to assess its effectiveness in management of patient symptoms and possible complications. Methods: Retrospective analysis of all patients operated between 2007 and 2015 at our tertiary care unit with sinonasal FD effecting sphenoid sinuses. Open or combined surgeries were excluded. Clinical examination results, radiological studies, operative findings and treatment outcomes were evaluated. Results: Ten patients with optic nerve encasement in 7 (70%) were included. All had headache which completely vanished in all postoperatively. Preoperative visual changes were detected only in 5 (50%) patients from whom symptoms have resolved completely in 2 (40%) and improved in 3 (60%) after surgery. No patients had postoperative additional visual deficit. During surgery there were no major bleedings, but in 2 (20%) cases CSF leakage was inevitable, which were recognized and repaired immediately. Postoperative imaging showed total resection in 7 (70%), gross total resection in 2 (20%) patients. One patient had only optic nerve decompression due to diffuse skull disease. In a mean follow-up time of 38 months, no recurrences or growth were detected except last mentioned patient. Conclusion: For removal of FD involving sphenoid sinuses, endonasal endoscopic approach reveals a viable technique with acceptable morbidity. Decision of surgery should be made carefully by evaluating radiological evidence for possible complications and by analyzing tumor growth and symptoms of the patients. For reducing recurrences total or gross total excision should be aimed which is achievable with this approach.

Modification of the inner flange of the Paparella type II ventilation tube for easier insertion

A simple modification of the inner flange of the Paparella type II ventilation tube is described to provide easier and faster insertion.