Sami Bercin

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.

Results of revision mastoidectomy.

Conclusions. Successful canal wall down (CWD) mastoidectomy requires removal of all diseased air cells, lowering of the facial ridge to the mastoid segment of the facial nerve, complete removal of the lateral epitympanic wall, and amputation of the mastoid tip. Additionally, the inferior canal wall should be lowered to adequately expose the hypotympanum, which allows a smooth transition into the mastoid cavity. An adequate meatoplasty is also necessary. Closed supratubal recess should be opened, anulus and tympanic membrane remnant should be removed in CWD cases. Revision mastoidectomy has a high success rate in obtaining a dry and epithelialized ear. Objective. This study reports revision mastoidectomy results and indicates factors that must receive attention in chronic otitis media surgery to produce less revision surgery. Patients and methods. Thirty-five patients who underwent revision mastoidectomy with or without cholesteatoma between 2005 and 2008 were analyzed retrospectively. Patients who had revision mastoidectomy with previous intact canal wall (ICW) or CWD mastoidectomies were included in the study. Results. Patients were aged 32–69 years (mean 57.4). There were 22 female and 13 male patients. Revision mastoidectomies were applied to 14 previous ICW and 21 prior CWD mastoidectomies. Of the 35 patients, 24 patients had cholesteatoma and 11 of them did not. Of the patients who had revision surgery, 10 had ICW mastoidectomy and 25 had CWD mastoidectomy. After revision mastoidectomy, at 3–25 months follow-up (mean 16.7 months), 29 patients had been successfully treated; they had dry well epithelialized cavity, with no findings of persistent, recurrent discharge or granulation tissue and cholesteatoma. In 21 patients in whom revision CWD mastoidectomy was performed, causes of failure of previous ear surgery in order of frequency were recurrent or persistent cholesteatoma and narrow meatoplasty (80.9%), persistent sinodural angle air cells and close supratubal recess (71.4%), high facial ridge and inadequate canalplasty (66.7%), persistent tegmental air cells and tympanic membrane remnant (57.1%), persistent mastoid apex air cells and open eustachian orifice (52.4%). Causes of failure after our revision ICW mastoidectomy in order of frequency were persistent or recurrent cholesteatoma (78.6%), closed supratubal recess (64.3%), persistent sinodural angle air cells, inadequate canalplasty and persistent mastoid apex air cells (57.1%), persistent tegmental air cells (42.9%).

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.

Transoral robotic lingual tonsillectomy in adults: preliminary results

Abstract Conclusion: Hypertrophy of lingual tonsils can be safely and effectively managed by transoral robotic surgery via a minimally invasive approach. The operating costs can be relatively high although the advantages to patients seem to justify the procedure. Transoral robotic surgery can represent the definitive treatment in hypertrophy of the lingual tonsils. Objective: The purpose of this work was to assess the feasibility, safety, and outcomes of transoral robotic surgery for lingual tonsillar hypertrophy in adults with obstructive sleep apnea. Methods: Retrospective medical records of six patients who underwent tongue base resection using the da Vinci Surgical Robotic System from September, 2012 through December, 2013 in a tertiary care hospital were evaluated. Demographic data, preoperative and postoperative polysomnography and Epworth Sleepiness Scale (ESS) scores, robot docking time, operative and postoperative aspects including surgical time, amount of bleeding, and early and late complications were collected and analyzed. Results: All patients successfully underwent lingual tonsillectomy using the da Vinci Surgical system. Transnasal endotracheal entubation was performed in all patients and they were all extubated before leaving the operation room. No tracheotomies were performed perioperatively for airway management. The patients were discharged on the fifth postoperative day. Operative time, estimated blood loss, and postoperative complication profiles were within the expected and acceptable limits for lingual tonsillectomy. There was a statistically significant decrease in apnea hypopnea index (AHI) (mean AHI from 27.5 to 6.3) and ESS scores (from 14.1 to 7.1).

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.

Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders

We investigated the prevalence of laryngopharyngeal reflux in patients with signs and symptoms of reflux, chronic otitis media and benign and malignant vocal cord lesions. Three groups of patients in Ankara Ataturk Education and Research Hospital ENT–Head and Neck Surgery Clinics were compared between 2005 and 2006. The first group had patients with signs and symptoms of reflux, the second group consisted of patients with chronic otitis media, and in the third group had patients with laryngeal pathology, i.e. vocal cord lesions. The results of pH monitoring of all the three groups of patients were analyzed for laryngopharyngeal reflux. In the evaluation, two different criteria, based on reflux number and time spent in reflux, were used. It was investigated whether there was a difference in terms of reflux among these three groups. Also, the effects of reflux in etiopathogenesis of chronic otitis media and vocal cord lesions are discussed. A total of 84 patients were studied, with 22 patients with signs and symptoms of reflux in Group 1, 42 patients with chronic otitis media in Group 2, and 20 patients with vocal cord lesions in Group 3. No statistical difference could be detected among the groups in terms of the two criteria mentioned above. The frequency of laryngopharyngeal reflux in patients with chronic otitis media and vocal cord lesions was found to be as high as than in the patients with signs and symptoms of reflux. During the treatment of chronic otitis media and laryngeal disorders, we advise reflux work-up, and in case if there is reflux, we recommend reflux treatment in addition to treatment of primary disease.

Efficiency of preoperative embolization of carotid body tumor

OBJECTIVE The purpose of this study is to compare the efficiency of preoperative embolization on vascular rupture rates during surgery in 13 patients within two groups. METHODS Retrospective medical records of 7 patients who did undergo preoperative tumor embolization and 6 patients who did not undergo embolization were reviewed. All patients underwent surgical resection of a carotid body tumor from 2010 to 2014 within a tertiary care hospital. Demographic data including age, gender, and tumor size were collected. Glomic artery supply was evaluated with digital subtraction angiography in each patient. The degree of flow reduction was calculated instantly following each injection of embolic material. Complications of embolization were also collected. The estimated blood loss and the operation time were obtained from intraoperative records and operative notes dictated at the time of surgery. Operative records were evaluated for carotid artery rupture and Shamblin classification of glomus tumors. RESULTS The mean patient age was 48.5 years (range 22-70), and 3 patients were male, 10 were female. All of the patients except one had Shamblin classification II. The mean diameter of tumor size was 4.42 cm. Relative rates of blood flow reduction during embolization were greater than 50% in 4 patients and 25-50% in 3 patients. Carotid artery injury was recorded in 4 patients within embolization group and in 1 patient within the other group. There were no significant differences between carotid artery rupture and embolization, blood loss, tumor size, and supplying artery. CONCLUSION Transarterial preoperative embolization of carotid body tumor does not seem to be helpful and should be discussed.

Oropharyngeal stenosis after transoral robotic lingual tonsillectomy.

Transoral robotic-assisted lingual tonsillectomy seems to confirm good tolerability with efficient results in both adult and pediatric populations, and the complication rate is usually dependent on the specific procedure and not related to the use of the robotic techniques. In these clinical reports, a 44-year-old woman (patient 1) and a 49-year-old woman (patient 2) were referred to our clinic with long-term complaints of dysphagia, snoring, and globus sensation. The patients were diagnosed with a lingual tonsillar hypertrophy, and lingual tonsillectomy was performed through transoral robotic surgery using the robotic da Vinci surgical system. After 2 months of uneventful follow-up, the patients returned with dysphagia, and examination of the patients revealed a cicatricial synechia surrounding the oropharynx. We report 2 cases of oropharyngeal stenosis that occurred during the late postoperative period after transoral assisted lingual tonsillectomy with epiglottoplasty. Possible risk factors and treatment alternatives were also discussed.

Consumer acoustic reflectometry: Accuracy in diagnosis of otitis media with effusion in children

OBJECTIVE Acoustic reflectometry is a technique based on a sonar that enables the diagnosis of middle ear effusion. We aimed to evaluate the accuracy and diagnostic value of consumer type acoustic reflectometry device for determining middle ear effusion in children. METHODS Acoustic reflectometry and tympanometries of 84 children, from 3 to 14 years of age, were done the day before they underwent adenoidectomy/adenotonsillectomy and myringotomy ± ventilation tube insertion under general anesthesia in the operating room with diagnosis of middle ear effusion. Their test results and the results of myringotomies, which is the golden standard technique in determination of otitis media with effusion, were compared. Specificity, sensitivity, positive and negative predictive values of both instruments in detecting middle ear fluid were determined. RESULTS Otitis media with effusion was detected in 106 ears (63.1%) during myringotomy. The sensitivity and specificities of acoustic reflectometry were found to be 83.33% and 68.18%, and tympanometry were 84.48% and 84.62%, respectively. The positive predictive value was 75.12% for acoustic reflectometry and 88.56% for tympanometry, and negative predictive values of acoustic reflectometry and tympanometry were 87.66% and 89.2%, respectively. The sensitivity of the AR was comparable to tympanometry (p > 0.01), however the specificity, PPV and NPV of AR were lower than tympanometry (p < 0.001). CONCLUSIONS Consumer type acoustic reflectometry is highly sensitive, objective and easy to perform technique for detecting otitis media with effusion, and it may help us to diagnose otitis media with effusion in early stages if used by family practitioners or parents.

Malignant eccrine spiradenoma on the lateral margin of nose as an infrequent localization.

Malignant eccrine spiradenomas are exceedingly rare tumors. They can arise from a preexisting eccrine spiradenoma or occur as a primary malignant tumor. Clinical features of these tumors may include a history of enlargement in a previously stable lesion. Tumor can be of low or high grade. Low-grade malignant eccrine spiradenoma has a better prognosis. We present a malignant eccrine spiradenoma arising from a preexisting eccrine spiradenoma, which has an infrequent localization between lateral edge of nose and medial canthus.