Israfil Orhan

Thermal burn of the larynx in an adult following hot water aspiration.

Thermal burns of the intraoral area after swallowing hot beverages are common and usually result in minor injuries with no serious lesions. However, burns of the oropharynx and larynx caused by swallowing hot beverages, while rare, can be much more serious and warrant special consideration. Most reported cases of such burns involve young children; among adults, only a few cases have been reported in the literature. We report the case of an adult person approval by the Local Ethics Committee who scalded his larynx after swallowing hot water. A 43-year-old man, who had been repairing a frozen motor with hot water, inadvertently sucked some of the boiling water into his mouth and throat. He aspirated a small amount of the hot water and immediately spit out the rest because of the extreme temperature. On initial physical examination, he had first-degree burns on his lips and slight scalding of the oral floor, buccal mucosa, and soft palate. Fiberoptic examination of the larynx revealed a swollen epiglottis. The surrounding supraglottic structures, including the aryepiglottic folds, arytenoids, and false vocal cords, were erythematous and edematous. The piriform fossae were narrowed. The vocal folds were reddish with no swelling (Fig 1). The patient’s oxygen saturation was 92 percent. The initial x-ray film showed clear pulmonary fields. After his emergency admission, the patient was treated with intravenous dexamethasone sodium phosphate 1 mg/kg and sefazolin sodium 2 g/day daily and periodic cold steam inhalation, and analgesic agents were added to the management for 4 days. Repeated fiberscopic examination of the larynx demonstrated reduced swelling of the epiglottis and its surrounding structures. The patient was discharged from the hospital on the fourth day.

Evaluation of the polymorphism in the Toll-like receptor 4 (TLR4) genes of tympanosclerosis patients

OBJECTIVE Although eardrum perforations which endure etiopathogenesis for a long-time and middle ear infections are proposed for causing the tympanosclerosis (TS), tympanosclerosis emerges in some chronic otitis media (COM), some of them do not appear although a continuing COM and enduring perforation last. In this study, the effect of the molecular reasons which display genetic differences in TS formation is evaluated; our aim is to determine the Asp299Gly polymorphism frequencies in the TLR4 gene of patients with TS who have COM, and patients who do not. MATERIALS AND METHODS Patients who have undergone COM surgery, were divided into two groups of 50 persons who were selected in accordance with the fact, whether they had TS in their middle ear cavity or not during operation. 100 healthy persons who had similar demographic data, were evaluated as the control group. The DNA isolation was executed by using standard methods with peripheric blood specimen of the diseased group and control group. The Restriction Fragment Length Polymorphism method was used in determining the Asp299Gly allel in the TLR4 gene. Items of 249 bc for the wild tip (Asp) post-restriction enzyme segment wild tip (Asp) allel, and 23 bc and 196 bc post-restriction enzyme segment polymorphic allel (Gly) were obtained. RESULTS TLR4 Asp299Gly polymorphism (10%) was asserted in a total of five specimens in the diseased group with TS. TLR4 Asp299Gly polymorphism was found positive in only one (2%) of the 50 phenomenons in the group without TS. TLR4 Asp299Gly polymorphism was found positive in six (6%) of the 100 phenomenons in the control group. The positive polymorphism in phenomenons with TS was significant in accordance with statistics, when compared with the group without TS (p<0.05). However, although the polymorphism rates were higher than the rates of the control group, it was not statistically significant (p>0.05). CONCLUSION TS may not appear in many patients who had undergone middle ear infection, and had perforation for many years. The polymorphism in arteriosclerosis in the TLR4 gene which caused the inflammatory cytokines oscillation recognize the bacterial LPS, was also accused. It is engrossing to find out from the results of our study on a restricted number of patients, and on only one gene, that molecular reasons which display genetic differences can also be effective in forming TS. Serial researches of greater dimensions are required.

The effects of aminoguanidine, methylprednisolone, and melatonin on nerve recovery in peripheral facial nerve neurorrhaphy.

Background:The medications may enhance the recovery after nerve paralysis. We aimed to evaluate the effects of aminoguanidine (AG), melatonin, and methylprednisolone on peripheral facial nerve neurorrhaphy. Methods:The buccal branch of the facial nerve was transected and autografted in 32 New Zealand rabbits. Subjects were divided into 4 groups equally (AG, melatonin, methylprednisolone, and control). After the medical treatment latency and amplitude were measured with nerve conduction study at 3, 6, and 10 weeks. Then, coapted segments of nerve were examined microscopically. The groups were compared with each other. Results:The latent period was shortened, and the amplitudes were increased in the AG group; the latent period was shortened, and the amplitudes did not show significant change in the melatonin group with the time. There were no significant differences between the amplitudes at 3 to 6 and 3 to 10 weeks in the methylprednisolone group, and the latent period was shortened. There was no significant difference between the amplitude values at 3, 6, and 10 weeks in the control group. In the histological examination, AG had the best influence on preventing myelin degeneration and reducing the accumulation of myelin debris. Considering the increase in collagen fibers, the best results were achieved in the melatonin group. The degree of myelin-axonal degeneration was higher in the methylprednisolone group. The degree of collagen fiber increase, axonal degeneration, myelin degeneration, and the accumulation of myelin debris were detected quite high in the control group. Conclusions:Aminoguanidine and melatonin alone achieved an increase in regeneration after peripheral facial nerve neurorrhaphy, but methylprednisolone did not. The best healing was determined in the AG group.

The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty.

AbstractThe aim of this study was to investigate the efficacy of tranexamic acid (TA) and methylprednisolone on periorbital edema, ecchymosis, and intraoperative bleeding in patients who underwent open septorhinoplasty (oSRP). Seventy-five patients performing hump extraction and osteotomies were allocated into 3 groups as follows: group 1, 25 patients as control; group 2, 25 patients who were administered oral TA as first dose 1 g starting 2 hours before surgery, 3 g daily in divided doses (1 g, every 8 hours) for 5 days; and group 3, 25 patients who were administered a single dose of 1 mg/kg intravenous methylprednisolone at the beginning of the surgery. Operation time, amount of intraoperative bleeding, and complications were recorded. Scoring of eyelid edema and periorbital ecchymosis was evaluated on postoperative first, third, and seventh days using scale of 0 to 4 by 2 observers. In groups using TA and methylprednisolone, periorbital edema and ecchymosis scores were significantly lower compared with the control group (P < 0.05). No significant difference was seen clinically and statistically in preventing or decreasing both periorbital edema and ecchymosis between group 2 and group 3. Patients given TA showed significantly less intraoperative bleeding compared with controls and patients who were administered methylprednisolone. We observed that the administration of methylprednisolone significantly decreases periorbital edema and ecchymosis. Additionally, our results support that TA use in patients who underwent oSRP with osteotomies was found clinically and statistically effective for prevention of bleeding during oSRP operations and reduction of both periorbital edema and ecchymosis.

The effect of BMP-2, BMP-4 and BMP-6 on bone destruction of cholesteatoma presence.

OBJECTIVE The aim of our study was to investigate the relationship between the destruction of temporal bone structures, ossicular chain destruction, dissemination of cholesteatoma and the expressions of bone morphogenetic proteins (BMPs), BMP-2, BMP-4 and BMP-6 in patients with acquired cholesteatoma. MATERIAL AND METHODS This study was performed in a total of 80 patients with cholesteatoma and without cholesteatoma who had undergone surgery due to chronic otitis media. The patients were grouped as the study and the control groups. The study group comprised patients with primary acquired cholesteatoma, and the control group consisted of chronic otitis media patients without cholesteatoma. The samples were obtained from cholesteatoma tissue and the external acoustic meatus skin in study group patients and they were obtained from the external acoustic meatus skin only in control group patients. The Reverse Transcriptase Polymerase Chain Reaction method was used for the measurements of BMPs, BMP-2, BMP-4 and BMP-6 expressions. Polymerase Chain Reaction was studied by isolation of Ribonucleic Acid from the tissue samples. RESULTS When the expressions of BMP in the external acoustic meatus skin were compared between the study and the control groups, the BMPs, BMP-2 and BMP-6 were determined to have a statistically significant relation in the study group (p<0.05), but BMP-4 was not significant (p>0.05). When the expression of BMP in cholesteatoma tissue was investigated in the study group patients, the BMPs, BMP-2 and BMP-6 were determined with statistically significant positivity (p<0.05), but there was no significant positivity for BMP-4 (p>0.05). In the study group, there was no statistical significance between the expressions of BMPs, BMP-2, BMP-4 and BMP-6 in cholesteatoma tissue, in the external acoustic meatus skin, and temporal and ossicular chain destruction, and dissemination of cholesteatoma (p>0.05). A statistically significant positivity for BMPs expression in cholesteatoma tissue was determined in patients with destruction of the incus+malleus+stapes (p<0.05). CONCLUSION The expressions of BMPs, BMP-2 and BMP-6, were elevated in cholesteatoma tissue. Furthermore, the positivity of BMPs expression was statistically significant in patients with destruction of all the ossicles, and we think that this marker can be used for evaluation of the aggressiveness of cholesteatoma.

The impact of pharyngeal repair time and suture frequency on the development of pharyngocutaneous fistula after total laryngectomy.

ObjectivePharyngocutaneous fistula (PCF) is the most common postoperative complication after total laryngectomy. The aim of this study was to determine the relationship between PCF with pharyngeal repair time and the number of mucosal sutures. MethodsThe medical records of 47 patients who underwent total laryngectomy were assessed prospectively. The pharyngeal repair time and the number of horizontal, vertical, and cricopharyngeal muscle sutures were recorded. We observed the occurrence of PCF in 14 patients (29.8%). The mean time for pharyngeal repair in the PCF group was 22 minutes 59 seconds ± 5 minutes, and the mean number of vertical, horizontal, and cricopharyngeal muscle sutures was 8.57 ± 2.6, 11.14 ± 2.1, and 8.45 ± 1.9, respectively. The mean time for pharyngeal repair in the non–PCF group was 22 minutes 21 seconds ± 5 minutes, and the mean number of vertical, horizontal, and cricopharyngeal muscle sutures was 9.54 ± 2.6, 10.84 ± 2.3, and 7.36 ± 2.7, respectively. The differences in the pharyngeal repair time and the number of vertical, horizontal, and cricopharyngeal sutures between the 2 groups were not statistically significant (P > 0.05). Besides, there was no statistically significant difference between the mean suture counts per centimeter in horizontal plane (1.46 ± 0.35) and vertical plane (0.98 ± 0.25) in the PCF group and the mean suture counts per centimeter in horizontal plane (1.42 ± 0.37) and vertical plane (1.13 ± 0.3) in the non–PCF group (P > 0.05). ConclusionsThere was no relation between PCF development with pharyngeal repair time, mucosal suture count, and suture frequency after total laryngectomy.

Tympanometric changes and eustachian tube function in patients with hypothyroidism.

ObjectiveThe aim of this study was to investigate the tympanometric changes and eustachian tube function (ETF) in patients with hypothyroidism. MethodsAutomatic ETF tests were performed and tympanometric measurements were evaluated to assess ETF in 40 patients diagnosed with hypothyroidism and a 40-patient euthyroid control group. Levothyroxine sodium tablet treatment was started in patients with hypothyroidism. After achieving a euthyroid state in these patients, the tympanometric measurements and automatic ETF tests were repeated. ResultsWhen the patient groups (hypothyroid and control) were compared in terms of ETF, a statistically significant ET dysfunction was observed in the hypothyroid patient group (P < 0.01).When hypothyroid patients were evaluated in terms of ETF before and after treatment, whereas 61.3% of cases had ET function before treatment, this ratio increased to 78.8% after treatment. Furthermore, according to pressure and compliance measurements, statistically significant increases were found in the after treatment measurements (P < 0.05). ConclusionsAs a result of this study, we have come to the opinion that hypothyroidism can change tympanometric measurements and also cause ET dysfunction. However, more comprehensive and detailed studies researching the effects of hypothyroidism on tympanometric measurements are needed.

Chemical injury of larynx after organophosphate ingestion.

Organophosphate (OPs) compounds are important insecticides used in agriculture and are possibly the most common acute poisonings in developing countries. Accidental exposure is the main cause for mild poisonings; severe cases are mostly due to suicidal use. We here report a person who attempted suicide by ingesting OPs. Laryngeal damage subsequent to aspiration of OP is herein described and discussed. Local ethics committee approval was obtained. A 38-year-old woman presented with severe cholinergic crisis after ingestion of an unknown amount of dichlorvos in a suicide attempt. In the intensive care unit, the diagnosis of OP intoxication was based on history, and confirmed by the clinical picture and decreased serum cholinesterase. The cholinergic crisis was improved by administration of antidotes. On day 3, the patient complained of progressive dyspnea and dysphonia after removal of the endotracheal tube. Fiberoptic examination of the larynx revealed epiglottitis. The surrounding supraglottic structures, including the aryepiglottic folds and false vocal cords, were erythematous and edematous. The vocal folds were swollen but found to have normal motility (Fig 1). The patient was administered antibiotic therapy and steroid intravenously. After consultation, periodic cold steam inhalation and analgesic agents were added to the therapy for 3 days. Two weeks after discharge, the larynx was completely healed with no evidence of residual damage.

Importance of sonographic paratracheal lymph node evaluationin early autoimmune thyroiditis.

BACKGROUND/AIM To review the sonographic views of paratracheal lymph nodes (PLNs) in the diagnosis and during different stages of autoimmune thyroiditis. MATERIALS AND METHODS Features of the PLNs (left and right), thyroid sonography, and laboratory data were investigated in 126 cases. Patients were divided into three groups by using thyroid sonographic criteria in the literature (group 1: control, group 2: early-stage/indeterminate, group 3: definite thyroiditis). Indeterminate patients were followed up for 1 year and included as indeterminate/early-stage thyroiditis patients. RESULTS Percentage of right and left PLN was 13.3% and 46.2% in control cases, 21.2% and 80% in early-stage/indeterminate cases, and 41.3% and 88.5% in definite thyroiditis cases. Significant among-group differences were evident in terms of right and left PLNs presence (Pearson chi-squared test, P = 0.011 and P = 0.001). CONCLUSION Careful and thorough review of the PLNs can ensure diagnosis of autoimmune thyroiditis even in cases of early stage of the disease and prevent false-negative diagnoses.

Infectious and Noninfectious Causes of Epiglottitis in Adults, Review of 24 Patients

Objective The present study reports the etiological differences, clinical features, management, and patient outcomes between infectious and noninfectious causes of epiglottitis in adult patients. Methods The medical records of 24 patients with infectious and noninfectious epiglottitis were investigated. Diagnosis was made by anamnesis and endoscopic examination. On admission, respiratory distress of patients was classified according to Freidmans classification. Results Fifteen patients were male, and nine patients were female. Their ages ranged between 24 and 69 years of age (mean, 43.4±11.6). In total, 16 patients were diagnosed with infectious epiglottitis, and eight patients were diagnosed with noninfectious epiglottitis. Of patients with noninfectious epiglottitis, two had angioedema, two had experienced organophosphate ingestion, one had experienced hot water aspiration, one had experienced hot milk aspiration, one had experienced foreign body aspiration (fishbone), and one had epiglottitis due to Behçets disease. Sore throat was the most common symptoms of infectious and noninfectious epiglottitis in our patients. Odynophagia was the second most common symptom of infectious epiglottitis, and muffled voice was the second most common symptom in noninfectious patients. Conclusion Epiglottit is an emergency situation; when a patient is diagnosed with epiglottitis, close follow-up should be performed, and airway support should properly be maintained according to the degree of respiratory distress. Tracheostomy should be performed without hesitation, as needed.