Muzaffer Kiris

Changes in serum IGF-1 and IGFBP-3 levels and growth in children following adenoidectomy, tonsillectomy or adenotonsillectomy

OBJECTIVE The aim of this study is to determine the effect of adenoidectomy, tonsillectomy or adenotonsillectomy on growth. For this purpose, we prospectively reviewed the postoperative changes in serum levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3), weight and height in children that underwent adenoidectomy, tonsillectomy or adenotonsillectomy. METHODS Ninety-six children with symptoms of sleep disordered breathing (SDB) or recurrent adenotonsillitis were enrolled to study. Blood samples were taken preoperatively and repeated at 6 months following operation to determine the changes in serum IGF-1 and IGFBP-3 levels, pre- and postoperative values of weight and height were recorded for each operation. RESULTS Thirty-six patients underwent adenoidectomy, 52 patients underwent adenotonsillectomy and 8 patients underwent tonsillectomy. Seventy of the operations were performed for SDB and 26 were performed for recurrent adenotonsillitis. The mean serum levels of IGF-1 increased by 26%, from 126.74+/-112.13 ng/ml to 159.82+/-122.91 ng/ml (p<0.001) and IGFBP-3 levels increased by 7%, from 3.34+/-1.17 microg/l to 3.57+/-1.16 microg/l (p<0.05) 6 months after operation. The increase was independent from the preoperative diagnosis. There was a significant increase both in patients with SDB and in children with recurrent infections (p<0.001 for IGF-1, p<0.05 for IGFBP-3). Their Z scores (standard deviation scores) for body weights (mean Z score from -0.06+/-0.98 to 0.118+/-1.18, p<0.001) and heights (mean Z score from 0.30+/-0.98 to 0.42+/-0.88, p<0.001) were significantly higher 6 months after the operation compared to preoperative period. CONCLUSIONS We found a significant increase in weight, height, and IGF-1 and IGFBP-3 levels of children with SDB or recurrent infections postoperatively. These results suggest that upper airway obstruction may not be the only mechanism that causes retardation on growth in children.

Prevalence and risk factors of otitis media with effusion in school children in Eastern Anatolia

OBJECTIVE To investigate the prevalence and demographic, environmental and child associated risk factors of OME in schoolchildren in Eastern Anatolia, Turkey, and analyze the results with reference to the review of the literature. METHODS A total of 2355 children who were attending two different primary schools, one located in low, and the other located in a high socioeconomic district of city of Van were screened and 2320 children who met the inclusion criteria were enrolled to study. Standardized questionnaires that include nine questions for determination of risk factors were delivered to the parents to be filled before examination of each child. All of the children underwent both otoscopic examination and tympanometric evaluation to provide high accuracy on the diagnosis of OME. The association between children diagnosed as OME and the answers to the questionnaires were evaluated. Also, teachers of the children were asked to complete a questionnaire evaluating childs level of school success, and the success levels of children with or without OME were compared. RESULTS The prevalence of OME was found to be 10.43%. Second-hand smoking (p<0.0001), low socioeconomic status (p<0.001), living in a crowded house (p<0.001), presence of atopy (p<0.01), lack of breast-feeding (p<0.05), presence of URTI (p<0.0001), young age (p<0.001) and snoring (p<0.0001) were found to be associated with prevalence of OME. No significance was found for duration of breast-feeding, gender, birth history and previous otolaryngological operations. Also, children with OME were tended to be less successful in terms of school success. CONCLUSIONS The potential of OME to cause serious sequelae and complications that may affect childrens life long-term, makes the disease an important health problem. Environmental, epidemiologic and familial factors play an important role in pathogenesis of OME. Caretakers must be informed about these highly modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.

Laryngeal amyloidosis. A rare cause of laryngocele

Laryngocele may be defined as an abnormal dilatation of the saccule of the ventricle and its pathogenesis is uncertain. We report a laryngocele caused by amyloidosis localized to larynx in a 60-year-old male patient. We would like to mention that amyloidosis should be evaluated in the etiology of patients diagnosed as having a laryngocele.

Endoscopic removal of a giant ethmoid osteoma with orbital extension.

Osteomas are slow growing bony tumours of the paranasal sinuses. They are usually asymptomatic but they may present with headache, cerebral symptoms, or visual disturbances, depending on their anotomical location. A computerized tomography scan is the imaging modality that should be choosen for the diagnosis of osteomas. Radiographically, osteoid osteoma appears as an opaque lesion with a nidus which has a radioluscent center surrounded by dense sclerosis. If treatment is indicated, external or endoscopic approaches can be chosen. We report a rare case of giant ethmoido-orbital osteoma which was treated via endoscopic approach. The endoscopic way is convenient and safe enough with advantages over the external approach. The decreased morbidity and better cosmetic results are clear advantages of this technique which has the potential to become the treatment of choice for selected ethmoid tumours, such as a giant tumour mentioned in this study.

When can lateral sinus thrombosis be treated conservatively

OBJECTIVE The purpose of this study was to review the clinical manifestations, radiologic findings, and treatment modalities of our cases with lateral sinus thrombosis (LST). METHOD Documents of patients with LST, diagnosed and treated from 1995 to 2001 in our clinic, were examined retrospectively. RESULTS Four patients with the diagnosis of LST were treated during this period. Among the clinical manifestations of these patients, the most frequently encountered symptoms were earache and headache, in addition to otorrhea and hearing loss. Four cases had chronic otitis media, three with cholesteatoma and one with polyps. Delta sign was detected in three cases on computed tomography, whereas a suspicious image was noted in one case. This case underwent magnetic resonance angiography, and the diagnosis of LST was established conclusively. In two cases, because pus was aspirated via lateral sinus punctures performed intraoperatively, these sinuses were explored and obliterated following radical mastoidectomy. Because pus was not aspirated via punctures of the other two cases, their sinuses were not explored. Only radical mastoidectomy was performed surgically for these cases. Dual antibiotics and low-dose anticoagulant therapy were given concomitantly to all cases in the postoperative period. Recanalizations of the nonobliterated lateral sinuses were detected with Doppler ultrasonography of internal jugular vena at 15 days and 3 months after the termination of postoperative treatment. CONCLUSION Clinical findings and radiologic techniques play an important role in the diagnosis of LST. In the treatment, if pus is found in the lateral sinuses, it is necessary to explore, clean, and obliterate them, whereas in cases in which the aspirates do not contain pus, mastoidectomy is sufficient. On the other hand, a low dose of anticoagulant can be used together with antibiotics in the nonobliterated lateral sinuses.

Evaluation and treatment of antrochoanal polyps

OBJECTIVES Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through a sinus ostium, and extends into the choana. The common presentation of ACP is unilateral nasal obstruction. The radiographic findings and differential diagnosis of ACPs are discussed by comparing them with data in the literature. METHOD This study included 19 (14 male, 5 female; median age 24.5 years, range 8-75 years) surgically treated patients with ACPs diagnosed by clinical examination, nasal endoscopy, and computed tomography. RESULTS Nasal obstruction was found in all cases. Endoscopic sinus surgery was preferred for removal of the nasal part of ACPs in 13 cases. Only in one case, polypectomy combined with Caldwell-Luc operation and septoplasty was performed. The observed complications were as follows: minor hemorrhage in three cases, mild cheek swelling with pain in two patients, and infraorbital hypoesthesia in one case. Histopathologic examination of ACPs revealed loose mucoid stroma and mucous glands, which were covered by respiratory epithelium. CONCLUSION Endoscopic sinus surgery may be indicated in patients with ACPs because the function and capacity of the maxillary antrum are preserved. The greater portion of the antral part of polyp can be removed while leaving the healthy antral mucosa intact.

Report of an Infant with Noma (Cancrum Oris)

Noma (cancrum oris) is an infectious disease that destroys the oro‐facial tissues and other neighboring structures in its fulminating course. The starting point of the disease is acute ulcero‐necrotic gingivitis, which results in an extensive gangrenous plaque destroying all of the soft tissues of the face. It predominantly affects children aged 2–16 years and is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene, as in developing countries. We discuss possible predisposing factors in cancrum oris such as malnutrition, infectious diseases, HIV infection, and immune compromise conditions. Poverty is the most important risk factor. We report the case of a 6‐month‐old child with noma and review the characteristic features of this disease.

Retrospective analysis of our cases with sudden hearing loss.

OBJECTIVE To determine the prognostic factors and healing ranges of patients treated for sudden hearing loss (SHL). PATIENTS AND METHODS In our study, 33 patients treated for SHL were evaluated between March 1995 and October 2001 retrospectively. After the routine examinations, first audiograms were done. The audiograms were classified as hearing loss in low frequencies, high frequencies, and flat using the Shey and Rubin classification systems. All patients were treated with the same standard regimen. The benefits of treatment were evaluated with the Siegel classification. RESULTS Various amounts of hearing gains were obtained in 17 of 21 patients treated in the first 5 days. No gain was obtained in 5 of 12 patients, who re-presented after the first 5 days of SHL. There was a statistically significant difference between the two groups (p =.005). There was hearing gain in all nine patients who had upward-sloping type of audiograms. Hearing gain was obtained in 8 of 12 downward-sloping type and 7 of 12 flat-type audiograms. There was a significant difference between the raising type group and the other groups (p =.04 and p =.014). Also, in 6 of 14 patients with vertigo and in 4 of 12 with bilateral sensorineural hearing loss (SNHL), there was no gain. CONCLUSION The prognosis of SHL is found to be better in patients who present early and mild SNHL and unilateral cases and worse in vertigo, bilaterally severe SNHL, and childhood.

Squamous cell carcinoma of the lower lip and supra-omohyoid neck dissection.

Abstract Purpose: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip. Patients and methods: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and/or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement. Results: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. Comment: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.

Is Aspiration Necessary Before Tympanostomy Tube Insertion

Aspiration of middle ear fluid after myringotomy is performed routinely, although investigators imply a cause‐and‐effect relationship between suction noise and acoustic trauma. This prospective randomized study investigated if aspiration was necessary. Fifty‐one myringotomies and 50 tympanostomy tube insertions were performed on 27 patients. A suction instrument was utilized in 24 ears and was not used in 27 ears. In a follow‐up period, no difference was observed between the two groups. The authors did not establish that aspiration is indeed harmful, but tympanostomy tube insertion can be performed without suctioning middle ear effusion.