Levent Soylu

Pharyngocutaneous fistula following laryngectomy

Pharyngocutaneous fistula (PCF) following laryngectomy is a serious complication, and its incidence varies from 7.6% to 50%. Despite the relative frequency of this complication, there is still uncertainty about the predisposing factors.

Hearing loss in Behçet's disease

In order to determine the characteristics and incidence of hearing loss in Behçets disease, 72 consecutive cases and 72 sex- and age-matched normal subjects were submitted to this study. Detailed audiologic tests were performed in all cases. Twenty patients (27%) showed some degree of hearing loss; but in only 7 patients (9%) was the average of the frequencies between 500 to 4,000 Hz more than 25 dB hearing level, and the cochlear function of 43 patients (59%) was within the 25-dB range in all frequencies. The averaged pure tone audiograms of the two groups showed a statistically significant hearing loss in the Behçets group. No relationship could be found between hearing loss and other system involvements. There was no correlation between hearing loss and duration of the disease, but the mean age of the Behçets patients with hearing loss was found to be significantly higher than the mean age of the patients without hearing loss.

The effectiveness of steroid treatment in nasal polyposis

OBJECTIVE The objectives of the management of nasal polyposis are to eliminate or reduce the size of polyps, reestablish nasal breathing, reduce symptoms of rhinitis, restore the sense of smell, and prevent the recurrence of nasal polyps. Local or systemic steroids have been used in the treatment of nasal polyps, but efficacy of combined (local and systemic) steroids in nasal polyposis has been little investigated. The aim of this study was to evaluate the influence of combined steroid therapy on the symptoms and extent of the disease in patients with nasal polyposis. METHODS Seventeen patients with nasal polyps were treated with combined steroids. Before and after the therapy, polyp size, nasal symptoms, sense of smell, and headache or facial pain were assessed by an established scoring system. RESULTS After the therapy, symptom scores of all the patients improved. Of the patients, 12% showed a polyp-free nasal cavity, 76% a clear involution of polyps, and 12% no response to the therapy. There were statistically significant differences (P<0.001) for symptom scores and polyp size. Medical ablation of polyps using steroids was not achieved in 88% patients. CONCLUSION Steroids can reduce polyp sizes and improve the symptoms, but are inadequate to eradicate the polyps. Surgery still plays a major part in the treatment of the nasal polyposis, but steroids can delay the necessity for surgical intervention.

Acyclovir in the Treatment of Recurrent Respiratory Papillomatosis: A Preliminary Report

INTRODUCTION In this study, we evaluate the effect of acyclovir in the treatment of recurrent respiratory papillomatosis (RRP), in addition to CO2 surgery. MATERIALS AND METHODS We include 12 patients who had aggressive RRP and required at least three prior endoscopic surgeries in this study. Acyclovir treatment started the day after the surgery. During the planned treatment period of 6 months, patients older than 5 years were asked to take the daily dose of 800 mg, and those younger than 5 years were asked to take 400 mg. RESULTS Nine of 12 patients were disease free during the follow-up periods, which ranged from 14 to 25 months with a mean of 18 months. Only 3 patients who used the drug inadequately required reoperation. CONCLUSION Because of the specific viral origin of RRP, we hope that addition of acyclovir to surgery will preclude or at least decrease the number of recurrences in this potentially fatal disease.

Vallecular cyst: a cause of failure to thrive in an infant

Congenital vallecular cyst is fairly uncommon in neonates and infants. Although benign in nature, it may cause stridor and even life-threatening airway obstruction in early infancy. A 3-month-old male baby presented with failure to thrive and respiratory distress was found to have a vallecular cyst. Marsupialization with CO(2) laser was performed.

Hydatic cyst in the head and neck area

Echinococcosis is a parasitic infection caused by the cestodes of genus Echinococcus. Most common form of this genu, Echinococcosis granulosus, is the causative parasite of hydatid cyst that occurs mainly in liver and lungs, and rarely in other internal organs. Canines are the definitive hosts. Cattle, pigs, sheep, and occasionally, man are the intermediate hosts for E granulosis. Therefore, this form of disease has its highest incidence in sheep-raising and cattle-raising regions, such as Africa, the Middle East, New Zealand, Australia, South America, and central Europe.‘*’ The adult tapeworms occur in the intestines of their definite hosts, whereas the larval stages proliferate asexually in various mammalian intermediate hosts. Humans and the other intermediate hosts become infected by ingesting eggs, which are passed in the feces of definitive hostss3 On the other hand, definitive hosts become infected by ingesting hydatid cysts in the organs of the intermediate hosts.3 Here we presented one case of hydatid cyst to remind otolaryngologists to consider this disease in the differential diagnosis of cervical masses. This is especially important in regions where Echinococcosis is endemic.

Changes of Middle Ear Mucosa in Secretory Otitis Media Treated with Ventilation Tubes

The present study was designed to obtain the precise ultrastructural status of the middle ear mucosa of patients to whom ventilation tubes were applied for the treatment of secretory otitis media (SOM). This study comprised 14 children with SOM aged 5-11. Normal epithelium obtained from otosclerotic patients as controls was composed of three main cell types; basal, ciliated, and secretory. Electron microscopic observations revealed that ciliated cells were almost completely absent in the epithelium of patients with SOM. Secretory cells, on the other hand, were noted to be increased in number with cytoplasmic features indicating active secretory phase; abundant secretory granules in these cells featured both serous and mucoid characteristics. Following the application of ventilation tubes, the micrographs exhibited a vast number of ciliated cells. Furthermore, the secretory cells were less conspicuous and the secretory granules were mostly serous in type. The ultrastructural findings of this investigation strongly suggest that the application of ventilation tubes in cases of SOM stimulates ciliated cell regeneration, inhibits secretion of mucoid material, and activates serous secretion; all of which eventually shorten the recovery period.

The wound amylase concentration in the prediction of pharyngocutaneous fistula.

Pharyngocutaneous fistula (PCF) is not uncommon after laryngeal surgery. Because it leads to prolonged hospitalization and increased patient morbidity, it is important to predict the formation of fistula. We studied the wound amylase concentrations of 87 consecutive laryngectomized patients. The PCF rate was 11.5% in this series. The amylase levels in patients with PCF begin to elevate significantly on the third, fourth, and fifth postoperative days. Our data indicate that increase in the wound amylase levels seems to be a significant predictor of PCF, and this should alert the surgeon for the presence of fistula.

Reflex sympathetic dystrophy following neck dissections

PURPOSE Reflex sympathetic dystrophy (RSD), which is a disorder that occurs after injury or surgery on the extremities, has not been reported as a complication of neck dissections until now. A group patients with head and neck cancer have been examined to determine the incidence of RSD in neck dissections. PATIENTS AND METHODS Forty-six patients with head and neck cancer, who had undergone neck dissections together with the removal of the primary tumor, were evaluated for RSD on their routine controls. RESULT AND CONCLUSION The presentation of RSD in two patients who were treated with radical neck dissection is probably a result of sympathetic hyperactivity that is secondary to surgical trauma.

Small cell carcinoma of the larynx

(Editorial Comment: These authors report a good response in patients treated for small cell carcinoma of the larynx with combination chemotherapy, including cisplatin and etoposide. Further observation will need to be made to corroborate these findings.) Primary small cell carcinoma (SCC) of the larynx is a rare malignancy associated with frequent, early, widespread metastases and poor prognosis.1-3 This tumor is thought to emerge from the argyrophilic Kulchitsky’s cells present in laryngeal mucosa.1*3 In the head and neck region, these tumors were also reported in the nasal cavity, paranasal sinuses, tongue, salivary glands, esophagus, and trachea.‘+3’4 A pproximately 0.5% of all primary laryngeal carcinomas are estimated to be SCCs, and approximately 125 cases have been reported in the literature.ls3 This tumor occurs mainly in men who have been heavy smokers, and it usually presents when the patient is between 60 and 80 years old.lp3 Patients often present with hoarseness and/or a neck mass. ‘p3r5 At the initial presentation, 50% of the patients had cervical nodal metastases,lV3 and other common sites of metastatic spread were liver, lung, bone, and bone marrow.1’3*5 The diagnosis is based on the light microscopic appearance, and immunohistochemical techniques and electron microscopy may be helpful in confirming the diagnosis. 306 The 2and 5-year survival rates were reported as 16% and 5% respectively,