Özmen Öztürk

The effects of topical agents of fluticasone propionate, oxymetazoline, and 3% and 0.9% sodium chloride solutions on mucociliary clearance in the therapy of acute bacterial rhinosinusitis in vivo.

Objectives The aims of the study were to determine: 1) how mucociliary activity in acute bacterial rhinosinusitis is affected; 2) how this activity is changed by therapy; 3) the effects of topical agents on mucociliary clearance, and 4) the most appropriate topical agent(s) to be used in the therapy of sinusitis.

Determination of Reactive Oxygen Species in Myringotomized Tympanic Membranes: Effect of Vitamin E Treatment

Objectives/Hypothesis Recent studies have established a strong relationship between the development of myringosclerosis and reactive oxygen species (ROS). The aims of the present study were to directly detect ROS in the tympanic membrane and middle ear mucosa of rats by measuring luminol amplified chemiluminescence, to evaluate the changes in the levels of ROS after treatment with vitamin E, and to examine the possible changes in the tympanic membranes otomicroscopically and histologically.

Endoscopic endonasal management of cerebrospinal fluid rhinorrhea.

Abstract The authors review their 5 years’ experience with endonasal endoscopic repair of the anterior skull base fistulas presenting with cerebrospinal fluid (CSF) rhinorrhea. A total of 12 patients were managed endoscopically between 2004 and 2008. Seven patients (58.3%) had nonsurgical posttraumatic CSF rhinorrhea, 2 patients (16.7%) had CSF rhinorrhea due to surgical/iatrogenic trauma, and 3 patients (25%) had spontaneous onset of CSF rhinorrhea. Radiosurgical correlation for CSF fistula identification was positive in all patients. The most common site of leak was the fovea ethmoidalis. The repair method consisted of an extradural underlay closure of a defect with fascia lata. The largest diameter of a defect to be closed was 15 mm. Immediate results were good in all patients, but later in the follow-up, CSF rhinorrhea recurred in 2 patients, and each patient had a revision 2 times. In the first revisions, transcranial approach was used, whereas in the second revisions endonasal endoscopic route was resorted. The primary closure rate was 83.3%, and the overall closure rate was 100%. The average follow-up period thus far is 21 months. Endonasal endoscopic technique well known to otolaryngologists should be considered as the first choice of surgery in the repair of CSF rhinorrhea because of low morbidity and a higher closure rate. The possibility of revision with the same technique makes this approach ideal for the repair of cranionasal osteodural defects.

Comparison of Transoral Power-Assisted Endoscopic Adenoidectomy to Curettage Adenoidectomy

IntroductionThe aim of this prospective and randomized study was to compare patients who underwent curettage adenoidectomy (CA) or transoral power-assisted endoscopic adenoidectomy (PAEA) performed as isolated procedures by a single surgeon over a period of 7 years. The success of an adenoidectomy has been evaluated by assessing the amount of reduction in the adenoid size and the symptomatic improvement at the sixth postoperative month.MethodsPatients’ nasal airway obstruction was graded by the parents of the patient on a visual analog scale (VAS), with a range from 0 to 10, with grade 10 representing total obstruction. The ratio of the choanal opening obstructed by an adenoid mass was measured and expressed in percentages as representative of the adenoid size. Preoperative and 6-month postoperative adenoid sizes were compared.ResultsFifty-three patients (CA group 27 patients/PAEA group 26 patients) completed the study. In the CA group, VAS score improved from the preoperative score of 8.63 ± 0.88 to the 6-month score of 2.22 ± 1.01 (P < 0.0001); and in the PAEA group, the preoperative VAS score of 8.69 ± 0.84 improved to 2.08 ± 1.05 in the same period (P < 0.0001). No statistical significance was found when VAS score improvements were compared (P = 0.4569). The average ratio of choanal opening obstructed by an adenoid mass improved from the preoperative ratio of 89.41% ± 6.48% to the 6-month ratio of 7.85% ± 2.28% in the CA group; and the preoperative ratio of 90.19% ± 6.95% in the PAEA group improved to 3.65% ± 1.38% after 6 months. The reduction of adenoid size was significantly superior in PAEA than CA (P < 0.0001). The operative time in PAEA was significantly shorter than that in CA (P < 0.0001).ConclusionAlthough symptomatic improvement at the 6-month follow-up is statistically indifferent, PAEA has been shown to be superior to CA with its superior performance in providing a near-total elimination of the adenoid mass in a shorter operating time.

A Case Report of a Malignant Peripheral Nerve Sheath Tumor of the Oral Cavity in Neurofibromatosis Type 1

Patients with neurofibromatosis type 1 develop both benign and malignant tumors at an increased frequency. Most of the malignant peripheral nerve sheath tumors (MPNSTs) are considered as high-grade sarcomas originating from tissues of mesenchymal origin. It is generally accepted that MPNSTs occur in about 2% to 5% of neurofibromatosis patients. In this paper, we present a 16-year-old male patient with neurofibromatosis who developed MPNST of the retromolar area. The mass enlarged rapidly in a period of 6 weeks. The patient was treated surgically, and a tumor mass with a diameter of 7 × 6 × 4 cm was excised, but after 8 months a recurrence was observed at the same site. The sarcomatous change in a neurofibroma has an extremely poor prognosis, so patients with neurofibromatosis should be closely monitored for a possible malignancy. A rapid change in size of a preexisting neurofibroma, infiltration of the adjacent structures, intralesional hemorrhage, and pain indicate a possible malignant transformation to MPNST.

Temporomandibular disorders in scuba divers-an increased risk during diving certification training.

Abstract The design of a diving regulator’s mouthpiece increases the risk of a temporomandibular disorder (TMD) in scuba divers. The total weight of a diving regulator is reflected directly on the temporomandibular joint, causing articular and periarticular disorders. In the current study, the prevalence of TMD in scuba divers triggered during diving certification training is investigated. We also aimed to determine the factors that lead to TMD during diving training and clarify the observation that there is an increased incidence of TMD in inexperienced divers. The study was held between 2006 and 2011. Ninety-seven divers were referred with the complaint of pain around temporomandibular area. The divers were classified according to their diving experience. Symptoms and signs of TMD were graded. Fourteen divers were diagnosed with TMD. Temporomandibular disorder was seen more frequently in inexperienced divers than in experienced divers (P = 0.0434). The most prevalent symptom was an increased effort for mouthpiece gripping. Temporomandibular joint tenderness and trigger point activation were the mostly seen physical signs. Thirteen divers had an improvement with therapy. The increased effort for stabilizing the mouthpiece is a recognized factor in TMD development. Attention must be paid to an association of scuba diving with TMDs, especially in inexperienced divers having a scuba certification training.

Pleomorphic adenomas recurrences within the parapharyngeal space.

This study was undertaken to evaluate and concentrate on the recurrent pleomorphic adenomas (PAs) of the parapharyngeal space. The records of 9 patients treated for recurrent PAs occupying parapharyngeal space were retrospectively reviewed. The study population comprised 6 women and 3 men with a mean age of 51 (range, 35-79 years). Before the first revision surgery, imaging studies and clinical examinations showed 1 solitary mass in 4 patients, 2 solitary masses in 3 patients, and 3 or more masses in 2 patients. After first revision surgery, 4 patients had rerecurrences with multinodular disease. Two of 4 patients underwent radiation therapy (RT), and the other 2 patients underwent second revision surgery, among whom 1 patient underwent third revision surgery, and the other one was also submitted to RT. Overall, 12 reoperations were performed, and at the end of all operations, 4 patients had rerecurrences and residual disease. In conclusion, we recommend RT to patients with multinodular disease, known tumor spillage, and residual tumor in addition to revision surgery. Histopathologic features, surgical resection, relationship to surrounding vital tissues, and postoperative adjuvant radiotherapy are the most important determinants for recurrent PAs.

Isolated fracture of the malleus handle

A61-year-old male patient with a history of right-sided sudden hearing loss in 1980 presented with progressive deterioration of hearing bilaterally for five years. In 1980, the patient consulted a local otolaryngologist with the complaints of sudden onset hearing loss and otalgia in his right ear after manipulation of his ear canal with his index finger while showering. The diagnosis at that time was otitis, and he began a course of antibiotics. Since 1980, the patient had been seen by various otolaryngologists and the problem that was causing the hearing loss was unnoticed. In our examination, otomiscroscopy showed an intact right tympanic membrane with an abnormal contour of the manubrium handle (Fig 1). Testing with a 512-Hz tuning fork was positive bilaterally for the Rinne test, whereas the Weber test lateralized to the right. Audiological evaluation showed a mild, sensorineural-type hearing loss in the left ear, and a mixed-type hearing loss with a 20to 45-dB air-bone gap that increased from mid to high frequencies in the right ear. Tympanometry showed increased mobility on the right. The patient refused any kind of surgery and was referred for hearing-aid evaluation. This report was approved by the local ethics committee of our department and carried out in accordance with the Declaration of Helsinki.

Surgery vs medical treatment in the management of PFAPA syndrome: a comparative trial

Background: Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a common disorder in children but there is little or no consensus on its optimal diagnosis and management. Objectives: To compare the outcome of different management approaches – medical therapy or tonsillectomy. Methods: The medical records of children diagnosed with PFAPA between 2008 and 2013 were retrospectively reviewed according to the modified Thomas test criteria. Patients were divided into two groups: group 1 for medical treatment – corticosteroids, a single intramuscular injection of methylprednisolone, and group 2 for surgery – tonsillectomy alone or tonsillectomy plus adenoidectomy .The course of the disease including the number and duration of episodes and the presence of remission, was documented. Results: 105 patients (30 in group 1, 75 in group 2) met the study’s inclusion criteria. Groups 1 and 2 were followed up for a mean (SD) of 23.6 (11.0) and 24 (10.3) months, respectively. At the end of the follow-up period, the number of episodes was 5.8 (6.3) vs 1.8 (1.9) (P<0.01) and their duration was 2.2 (1.3) vs 1.1 (0.8) days (P=0.03), both of which were significantly lower in group 2.The need for hospitalization during this period was significantly lower for group 2 at 1.1 (2.0) vs 0.1 (0.3) (P<0.01) and the remission rate in group 2 was significantly higher than in group 1 (98.6% vs 56.6%, P<0.01). Conclusion: This study demonstrated that surgery is superior to medical treatment for PFAPA in terms of increased remission rates and a decrease in the number and duration of episodes.

Chlamydia Trachomatis Tonsillopharyngitis

Reports about the extragenital spread of Chlamydia trachomatis (CT) to oropharynx are limited. We report a male patient with progressive tonsillopharyngitis resistant to amoxicillin/clavulanic acid therapy. The patient presented 9 days after an orogenital and oroanal sexual intercourse with a female sex worker. The microimmunofluorescence revealed CT tonsillopharyngitis, and after completing a one-week course of doxycycline, the patient recovered completely. More cases of CT tonsillopharyngitis may be revealed if attention is paid to an association of sexual activity with enduring tonsillopharyngitis.