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Accessory Nerve Function After Modified Radical and Lateral Neck Dissections

Objectives: Evaluate preoperative and postoperative electrophysiological changes related to the accessory nerve with reference to dissection technique, modified radical neck dissection, and lateral neck dissection.

Preliminary report on L-forms: possible role in the infectious origin of secretory otitis media.

Infection and inflammation of the middle ear cleft are important factors in the pathogenesis of secretory otitis media. Although high percentages of negative cultures are confronted in many studies, strong evidence pointing to the infectious nature of this disease could not be overlooked. Many authors agree about the failure of conventional culture methods in identifying the responsible pathogen or pathogens. Besides, some agents, such as some kinds of antibiotics, lysozyme, and perhaps some undetected materials, are capable of changing bacterial behavior and consequently the clinical course. Effusions taken from 40 ears with secretory otitis media were cultured by means of conventional brain-heart infusion broth and special hypertonic thioglycollate broth. Strikingly, bacterial L-forms were detected in 6 specimens in thioglycollate broth, with no growth in the conventional broth. We concluded that these atypical forms of bacteria, the L-forms, may play an important role in the bacteriologic aspect of secretory otitis media.

Mini-Incision for Pediatric Cochlear Implantation with a MED-EL Device

Objective: Minimal invasive approaches have been described for cochlear implantation. However, the number of reports about minimal invasive approaches for MED-EL devices is sparse. In this technical note, we describe our pediatric cochlear implantation and incision techniques for MED-EL devices. Methods: Among 92 cochlear implantations performed between November 2002 and November 2006, there were 32 consecutive pediatric cochlear implantations with MED-EL devices which were performed between July 2005 and October 2006. In our technique, standard posterior tympanotomy and cochleostomy were performed after 4- to 5-cm mini-incisions in the postauricular region. However, suture fixations were not used for the implant receiver nor its electrode. Results: There were 14 girls and 18 boys with a mean age of 3.9 years. The mean follow-up duration was 5.8 months. No flap necrosis, hematoma or infection, nor implant migration, extrusion or breakdown were encountered. Revision surgery was performed in 3 patients due to cochlear ossification, perilymph leakage and extracochlear implantation. Conclusion: MED-EL implantation can be performed using small incisions without suture fixation of the receiver and its electrode.

Scanning electron microscopy of hydroxylated polyvinyl acetal and conventional gauze strip nasal packing materials.

The application of nasal packing is one of the most commonly performed procedures in rhinology. Various materials have been used as nasal packing, including conventional gauze strips and hydroxylated polyvinyl acetal. Complications related to nasal packing may cause problems that lead to increased morbidity. Among those complications, infectious ones range from localized infection in the nasal cavity to toxic shock syndrome. The purpose of this study was to evaluate conventional gauze strips and hydroxylated polyvinyl acetal nasal packing materials by scanning electron microscopy to reveal their surface characteristics that would promote or prevent the development of infectious complications. The two types of materials were examined before and after application into the nasal cavity. Scanning electron microscopy demonstrated that hydroxylated polyvinyl acetal material had a smooth surface, whereas conventional gauze strips had an irregular surface with fibers projecting, thus increasing the surface area for bacterial adherence and allowing possible evasion of bacteria from the elements of the immune system within this fibrillar structure.

KRONİK OTİTİS MEDİA CERRAHİSİNDE GREFT BAŞARISINI ETKİLEYEN FAKTÖRLER / FACTORS INFLUENCING GRAFT SUCCESS IN CHRONIC OTITIS MEDIA SURGERY

OZET: Bu calismada, kronik otitis media sebebiyle opere edilen hastalarda, greft basarisini etkileyen faktorler arastirilmistir. Calismamizda 1999-2001 yillari arasinda opere edilmis 126 vakanin 137 kulagi prospektif olarak incelenmistir. Ortalama takip sureleri 15 ay olarak belirlenmistir. Vakalar kendi aralarinda preoperatif otoskopi ve intraoperatif bulgularina gore 5 gruba ayrilmistir. Kronik otitis media tipleri arasinda cerrahi sonuclarinda, isitme ve morfoloji acisindan basari farki bulunamamistir. Preoperatif isitme duzeyinin, postoperatif isitme kazancini etkiledigi belirlenmistir. Hastalardaki kemikcik harabiyetinin postoperatif isitmeyi olumsuz etkiledigi, kullanilan isitme rekonstruksiyonu yontemleri arasinda fark olmadigi belirlenmistir. Kullanilan cerrahi tekniklerden acik teknigin, isitme sonuclarini olumsuz etkiledigi gosterilmistir. Orta kulak mukozasinin isitme sonuclarina etkisi yoktur. Orta kulak mukozasi odemli ve islak olanlarda, greft basarisi daha dusuktur. Kulak zari perforasyonu olan vakalarda perforasyon yerinin greft basarisinda etkisi oldugu gorulmustur. Mastoidektominin ve aditus ve antrum arasindaki gecisinin greft basarisinda etkisiz oldugu belirlenmistir, Mastoidektominin secilmis vakalara uygulanmasi gerektigi dusunulmustur. Sonuc olarak, kronik otitis mediada cerrahi basariyi etkileyen pek cok faktor vardir. Bu faktorler dikkatlice incelenip, daha iyi cerrahi basariya ulasmak icin, her hastanin ozellikleri degerlendirilmelidir. ANAHTAR KELIMELER: otitis media, otit, timpanik membran perforasyonu, greftler, isitme. FACTORS INFLUENCING GRAFT SUCCESS IN CHRONIC OTITIS MEDIA SURGERY ABSTRACT: In this study, factors affecting the graft success was investigated in patients who were operated due to chronic otitis media. In this study, 137 ears of 126 patients who were operated due to chronic otitis media between 1999-2001 were evaluated prospectively. The mean follow up period was 15 months. The patiens were classified to five groups according to the preoperative otoscopic examination. The postoperative assessment of hearing level showed that there was no significant difference between groups with regard to hearing gain. The ossicular chain erosion decreased the hearing gain in all groups and there was no significant relationship between the hearing gain and ossicular reconstruction method. The patients who underwent canal wall down procedure had poor hearing level in postoperative period. Although the properties of middle ear mucosa had no effect on hearing gain. The graft take rate was lower if the middle ear mucosa was edematous and wet. The site of the tympanic membrane perforation was one of the factors influencing the graft take rate. The graft take rate was found to be independent of cortical mastoidectomy and a functional aditus ad antrum. As a conclusion, in chronic otitis media surgery there are many factors which can effect the success rate of the operation. An otologic surgeon should consider all these factors and should evaluate every patient’s features to achieve better surgical success. KEYWORDS: otitis media, otitis, tympanic membrane perforation, grafts, hearing.

Relationship between tumour-node-metastasis stage of laryngeal squamous cell carcinoma and duration of symptoms

OBJECTIVE To evaluate the relationship between disease stage and duration of symptoms for squamous cell carcinoma of the larynx. METHOD We evaluated retrospectively data from 102 laryngeal squamous cell carcinoma patients seen in the otorhinolaryngology department of the Gazi University School of Medicine between December 1996 and June 2004. Inclusion criteria were a histologic diagnosis of laryngeal squamous cell carcinoma, no previous medical, surgical or radiological treatment for carcinoma, and the absence of any other primary tumours or distant metastatic disease. RESULTS There was no relationship between duration of symptoms and stage of the disease, both for glottic and supraglottic tumours. When glottic and supraglottic tumours were compared, no significant difference in symptom duration could be found. CONCLUSION There is no correlation between symptom duration and the stage of the disease for squamous cell carcinoma of the larynx. Therefore, symptom duration does not reflect the stage of the tumour.