Selçuk Güneş

Subperiosteal temporal pocket versus standard technique in cochlear implantation: a comparative clinical study.

Objective: In the standard technique of cochlear implantation, the internal receiver-stimulator (IRS) is fixed into a socket drilled on the calvarial bone. In the subperiosteal technique, the IRS is fixed under the subperiosteal plane, and drilling is not necessary. The purpose of this study was to compare the subperiosteal and the standard techniques. Study Design: Retrospective clinical study. Setting: Tertiary referral center; cochlear implant program. Patients: One hundred forty-eight patients who underwent cochlear implantation. Intervention: The researcher who evaluated the patients was not informed which of the 2 techniques was used on the patients and administered a visual analog scale (VAS) analysis. The duration of the operation, intraoperative and postoperative complications, and migration of the IRS were assessed. Main Outcome Measures: A VAS survey was administered to the patients or to their parents to evaluate the practicability of the implant. Results: The duration of the operation was 73.4 ± 17.8 minutes in the subperiosteal group and 105.5 ± 17.8 minutes in the standard technique group. The difference was statistically significant. Intracranial complications or migration of the IRS was also not observed in any patient. The VAS score was 4.2 ± 2.1 in the standard group and 4.3 ± 1.9 in the subperiosteal group. The difference was not statistically significant. Conclusion: The subperiosteal technique can be safely and effectively used in cochlear implantation. Not only are there no intracranial complications and no migration of IRS was observed but also the mean operation time is reduced up to 30% and none of the patients have reported difficulty with fixing of the external device.

Treatment of traumatic tympanic membrane perforations

will alter the healing pattern. 48 h after trauma, epithelial hypertrophy and closure of TM edges were begun and then followed by the development of fibrous components of lamina propria [2]. We excluded subjects with these properties to evaluate the hyaluronic acid (HA) ester patching in a more precise group and tend to limit the additional factors that will affect the healing process of the eardrum. The perforation size was graded with a well-accepted author’s classification o ease the perforation of ear drum as less than 25%—more than 25% and less than 50%—more than 50% but not total—and 100% or total. This is an easy and very valuable grading as most of the authors used this classification on ensuing studies [4]. The author noted that most of the perforations were at early stage. Our study included the subjects which were enrolled in 6 month period and the results were given as they were at the end. The large perforations did not widely seen in the study period. This is reasonable, since most of the traumatic membrane perforations occurred as small to medium size perforations. The author noted that we reported closure rate of 94.8% in the Epifilm patch-treated group in mean 6 week period which was consistent with the literature [1]. The author noted some studies which reported different closure times changing from 28 days to 3 months according to different perforation size [2, 5–7]. However, all these studies have different type of perforation grading, follow-up periods, and outcome presentation. The seeking for an ideal patching material was done why the perforation-related problems such as middle ear infection, tinnitus, etc. was seen in closure period and we aimed to fasten the healing. Second reason for our searches is the possibility of healing failure. In this case, a myringoplasty will be needed which has remarkably high patient We read the letter to editor entitled “Effect of hyaluronic acid with or without scaffold material on the regeneration of tympanic membrane perforations” by Zheng-Cai Lou [1]. It is an interesting paper that containing some criticism about our manuscript entitled “A prospective controlled trial comparing spontaneous closure and Epifilm patching in traumatic tympanic membrane perforations” [2]. The author proposed that our study design is not appropriate. We performed a prospective controlled trial. We had excluded subjects who had previous middle ear history, active middle ear drainage, temporal bone fracture, and subjects who admitted 72 h after trauma. The previous middle ear history is a sign middle ear ventilation dysfunction. In the presence of active middle ear drainage, it is impossible to replace the patch and it is also associated with permanent ear drum perforation. Lee et al. reported that the perforation closure rates were 3.121 times higher in patients without otorrhea on the initial visit when compared with the subjects who had active otorrhea on the initial visit [3]. The mechanism of eardrum perforation in temporal bone fractures is completely different from the barotrauma, since it is occurring as a result of the fracture of the bone and the tympanic membrane annulus and supporting bone fracture

Management of Laryngoceles by Transoral Robotic Approach.

Objectives:Laryngoceles are air-filled sacs which communicate with the laryngeal lumen. When filled with mucus or pus, they are called laryngomucoceles and laryngopyoceles, respectively. Transoral robotic surgery (TORS) is a new and remarkable technique that expands its usefullness in otorhinolaryngology. Conventional treatments for laryngoceles were previously performed using external approaches, with aesthetically unfavorable and less function-sparing results. Transoral laser microsurgical approaches for laryngoceles were seldom reported. It is aimed to present authors’ clinical experience on laryngocele management with TORS which is a rather new technique. Study Design:A retrospective patient serial. Methods:Patients were evaluated for demographic data, type of lesion, reasons for hospital admittance, complaint duration, and previous surgery. Robotic surgery panel including anesthesia time, duration of surgery, need for tracheotomy, postoperative care, follow-up, and recurrence rates were also summarized. Results:Six men (mean age 51.7 years; range 41–62) with laryngoceles underwent successful TORS. Dyspnea and hoarseness were the main complaints. Two patients had undergone previous laryngeal surgery due to laryngeal cancer, with no recurrence of malignancy at admittance for laryngocele. Three had simple laryngocele, 2 had laryngomucocele, and 1 had laryngopyocele. No laryngoceles recurred and no complication such as dysphonia or prolonged dysphagia occurred. Conclusion:Transoral robotic surgery was found superior in safety, technical feasibility and curative effectiveness, when compared with classical methods, especially due to absence of skin incisions. Surgical modalities for laryngocele excision should be directed toward a curative target including cosmetic and functional success, technical achievability, and surgically curative methods. Transoral robotic surgery provided all these features.

Glanzmann's thrombasthenia: a rare case of spontaneous bilateral hemotympanum

O hemotimpano pode ocorrer em decorrencia de varias con -dicoes, incluindo fratura do osso temporal, tamponamento nasal, epistaxe, terapia anticoagulante e doencas hemato-logicas. A trombastenia de Glanzmann, uma doenca hemor-ragica congenita rara, representa uma causa pouco frequente de hemotimpano. Apresentamos aqui um caso de hemotimpano bilateral espontâneo em trombastenia de Glanzmann.

Atypical Metastasis to the Head and Neck Region: An Analysis of 11 Patients

Objective We present 11 patients with distant metastases to the head and neck from an infraclavicularly located primary tumor and discuss the management strategies including the clinical presentation, treatment modalities, and prognosis. Methods The retrospective data of the pathology reports and operation notes of 1239 patients who had undergone any kind of oncological surgical intervention between 2005 and 2017 were analyzed. All of the 11 patients included in the study were evaluated in our departments tumor board, and all patients with an operable lesion had undergone surgery. Inoperable patients were treated with chemotherapy and/or radiotherapy. Results The average age of the patients was 64.3 (48-88) years. Primary tumors were located in the lung (2), breast (2), ovary (2), prostate (2), kidney (1), and colon (1) and the primary lesion could not be determined in one patient. The most common symptom was newly occurred painless swelling (9/11, 81.8%) at the metastatic site. Four patients without any other distant metastases were operated. Of these four patients, two died during follow-up due to systemic disease, and the other two are alive and disease-free. Three of the seven inoperable patients were treated with chemotherapy and the other four with radiotherapy. The prognosis of this group was worse. Conclusion Although metastasis to the head and neck is not common, it is vital to keep in mind while approaching a patient with a lesion at the head and neck region especially if there is a history of lung, breast, and genitourinary cancers. Despite the poor prognosis, diminishing the tumor burden would increase the treatment success.

The Ignored Parameter in the Diagnosis of Obstructive Sleep Apnea Syndrome The Oxygen Desaturation Index

Objective The apnea-hypopnea index (AHI) does not provide information about the apnea depth and length. We aimed to evaluate the correlation of the oxygen desaturation index (ODI) with AHI and the subjective symptoms because it is known that hypoxia plays an important role in morbidity and complications of obstructive sleep apnea syndrome (OSAS). Methods We reviewed the data of patients who applied to our clinic between 2010 and 2014 and underwent polysomnography (PSG) with a diagnosis of suspected sleep apnea. The demographic and anthropometric data of the patients were recorded. Epworth sleepiness scale (ESS) and values of AHI and ODI were analyzed in PSG. Results A total of 321 patients were divided into four groups, according to AHI as follows: 82 (25.5%) common snoring, 77 (24%) mild obstructive sleep apnea (OSA), 71 (22.1%) moderate OSA, and 91 (28.3%) severe OSA. A strong correlation was detected between AHI and ODI (p<0.005 and r=0.904) in all patient groups. There was a positive correlation between AHI and ESS (p<0.05 and r=0.435), but the correlation of ESS with ODI was stronger than that with AHI (p<0.05 and r=0.504). Conclusion The subjective symptoms of sleep apnea syndrome seem to be closely related to oxygen desaturations. Hypoxia during apnea periods of OSA is important; therefore, we suggest that ODI is as valuable as AHI in diagnosing and grading the OSAS.

Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle

INTRODUCTION Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. OBJECTIVE The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. METHODS In total, 29 male patients (average years 58.20±9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. RESULTS The mean maximum phonation time was 8.68±4.21s in Group A and 15.24±6.16s in Group B (p>0.05). The S/Z (s/s) ratio was 1.23±0.35 in Group A and 1.08±0.26 in Group B (p>0.05); the voice handicap index averages were 9.86±4.77 in Group A and 12.42±12.54 in Group B (p>0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73±3.08 in Group A and 13.64±1.49 in Group B (p>0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21±4.11, 32.21±6.85, and 20.14±2.17 in the Group B, and 29.20±2.54, 32.4±4.79, and 19±1.92 in Group A, respectively. CONCLUSION Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

Serum Calcitonin Levels may be Used in the Differential Diagnosis of Vagal Glomus

1Istanbul Bakirköy Dr. Sadi Konuk Research and Training Hospital, Department of Otorhinolaryngology, Istanbul, Turkey 2Istanbul Bakirkoy Sadi Konuk Research and Education Hospital, Department of General Surgery, Division of Endocrine Surgery, Istanbul, Turkey 3Istanbul Bakirköy Dr. Sadi Konuk Research and Training Hospital, Department of Pathology, Istanbul, Turkey 4Istanbul Bakirköy Dr. Sadi Konuk Research and Training Hospital, Department of Endocrinology, Istanbul, Turkey *Corresponding author Mustafa Çelik, MD Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital Department of Otorhinolaryngology Head and Neck Surgery Zuhuratbaba Mah, Tevfik Sağlam Cad. No:11, Bakırköy, Istanbul Turkey Tel. +90 212 414 7253 Fax: +90 212 542 44 91 E-mail: dr.mcelik@yahoo.com

Carotid Artery Aneurysm: A Rare Cause of Hemotympanum.

Abstract Temporal bone fractures can occur as a result of various head trauma. The most common cause of the hemotympanum is traumatic temporal bone fracture. Facial paralysis and hearing loss can be seen associated with temporal bone fracture. The development of the internal carotid artery aneurysm after temporal bone fracture is extremely rare. In this article, the authors evaluated carotid artery aneurysm that developed after temporal fracture and aneurism compressed by coagulated blood mass which showed itself as a hemotympanum. The internal carotid artery aneurysm that induced by temporal bone fracture and presented as hemotympanum has not been reported yet. This patient is the first case in the literature. Diagnosis, treatment, and follow-up options will be discussed in the light of current literature.