Mete Kiroglu

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.

Surgical and medical management for complications in 475 consecutive pediatric cochlear implantations

OBJECTIVE The purpose of this study is to assess complications occurring after cochlear implantation (CI) in children and to discuss revision surgeries and medical interventions occurring during follow-up. STUDY DESIGN Retrospective study of 475 consecutive pediatric cochlear implantations at a tertiary referral center. METHODS The patients (n = 475) who received cochlear implants in our institution between March 2000 and March 2012 were followed up (range, 5 months-12 years). All complications were systematically reviewed, and their causes were analyzed for prevention and therapy. RESULTS All children received unilateral CI. Mean age at implantation was 3 years 7 months (ranged from 10 months to 18 years). Forty-three patients (9%) experienced complications. Twenty-one patients (4.4%) had major complications, consisting of device failure (10 patients), flap necrosis (4 patients), meningitis (2 patients), electrode shifting (2 patients), hematoma (2 patients) and magnet migration (1 patient). Twenty-two (4.6%) had minor complications, consisting of acute otitis media (5 patients), skin lesion due to pressure reaction in contralateral ear during surgery (4 patients), flap swelling (3 patients), minor wound infection (3 patients), transient facial paralysis (2 patients), transient vertigo (2 patients), hematoma (1 patient), facial stimulation (1 patient), subcutaneous emphysema (1 patient). Complications led to reimplantation in 13 (30.2%) and other revision surgery in 7 (16.2%) of the 43 patients. One patient with meningitis cured with medical treatment and 22 patients with minor complications cured with either medical treatment or spontaneously. CONCLUSIONS Cochlear implantation is a safe technique in experienced hands with a relatively low complication rate. Long term follow up is mandatory to minimize and control surgical complication.

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.

The role of food allergy in otitis media with effusion

OBJECTIVE: To detect the relationship between food allergy and otitis media with effusion (OME). MATERIALS AND METHODS: This study was performed on three different groups. The patient group was made up of 56 patients with OME (group I). There were 28 patients with food allergy in group II and these patients were investigated for OME. The control group consisted of 28 patients without any complaints concerning food allergy or OME (group III). RESULTS: Food allergy was detected in 25 patients with OME (44.6%) (group I). In patients with food allergy (group II), OME was detected in 7 patients (25%). In the control group (group III) food allergy was diagnosed in 5 patients (18%) and OME in 1 patient (3%). The incidence of food allergy in OME group was statistically significant when compared to the normal group (P > 0.05). CONCLUSIONS: This study demonstrates that food allergy may play a role in the etiopathogenesis of OME. (Otolaryngol Head Neck Surg 2004;130: 747-50.)

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.

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.

Connexin 26 and 30 mutations in paediatric patients with congenital, non-syndromic hearing loss treated with cochlear implantation in Mediterranean Turkey.

OBJECTIVE Mutations in the genes for connexin 26 (GJB2) and connexin 30 (GJB6) play an important role in autosomal recessive, non-syndromic hearing loss. This study aimed to detect the 35delG and 167delT mutations of the GJB2 gene and the del(GJB6-D13S1830) mutation of the GJB6 gene in paediatric patients diagnosed with congenital, non-syndromic hearing loss and treated with cochlear implantation in Mediterranean Turkey. MATERIALS AND METHOD We included 94 children diagnosed with congenital, non-syndromic hearing loss and treated with cochlear implantation. Blood samples were collected, DNA extracted and an enzyme-linked immunosorbent assay performed to enable molecular diagnosis of mutations. RESULTS Of the 94 children analysed, the 35delG mutation was detected in 12 (12.7 per cent): 10 (83.3 per cent) were homozygous and 2 (16.7 per cent) heterozygous mutant. The 167delT and del(GJB6-D13S1830) mutations were not detected. CONCLUSION The GJB2-35delG mutation is a major cause of congenital, non-syndromic hearing loss in this study population.

Aplasia of bilateral uncinate processes with a bilateral nasomaxillary cavity

Aplasia or hypoplasia of the uncinate process is associated with maxillary sinus aplasia or hypoplasia. It is of particular clinical importance to recognize the presence of normal or abnormal uncinate processes in patients who will undergo surgical procedures for paranasal sinus diseases. In this report, we present a case of aplasia of bilateral uncinate processes, discuss the variations of uncinate processes, and review related literature.

Gastric cyst of the oral cavity

A case of a heterotopic gastric cyst of the oral cavity is described and a review of the literature, with emphasis on the possible etiological theories of this rare lesion, is presented. This developmental lesion is found more commonly in males. It most likely arises from misplaced embryonal tissue. Surgical treatment is the preferred choice of treatment, and CO2 laser is a safe alternative surgical approach for the removal of this lesion.

Choice of cochlear implant side in a paediatric population.

OBJECTIVE To compare the effect of right- or left-sided cochlear implantation on listening skills in a paediatric population. METHODS A retrospective analysis was conducted on the listening skills performance data of children who were operated on and followed up at the Çukurova University Department of Otorhinolaryngology between 2007 and 2011. Sixty-three patients were included in the study. Patients were evaluated using the Listening Progress Profile, the Meaningful Auditory Integration Scale and the littlEARS test. RESULTS The mean age of the children was two years (range of one to five years). Twenty-nine patients were male and 34 were female. Twenty-eight patients were implanted in the right ear and 35 in the left ear. There were no statistically significant differences between right and left ear implantees in terms of listening skills performance. CONCLUSION This study indicates that the choice of cochlear implant side is not crucial for the development of listening skills.