Taner Yılmaz

Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children

Abstract We investigated the clinical value of intranasal budesonide in acute sinusitis in 52 children with acute maxillary sinusitis. We randomly divided them into two groups: group 1 received oral pseudoephedrine (2 × 30 mg) and cefaclor (40 mg/kg) for 10 days, and group 2 received intranasal budesonide (2 × 100 μg) and cefaclor (40 mg/kg) for 10 days. Symptoms of headache, cough, and nasal stuffiness and signs of nasal discharge were graded before and after treatment. The patients whose symptoms and signs completely normalized after treatment were considered to have recovered, and those with persisting symptoms and signs after treatment as having not recovered. The results of the two treatment groups were compared. The recovery rate of the children in group 2 were significantly higher than those in group 1 (P < 0.05). No adverse drug effects were determined during the study period. These findings suggest that topical steroids may be a useful adjunctive agent in the treatment of acute sinusitis of children without apparent side effects and can possibly hasten the resolution of symptoms.

Prognostic significance of vascular and perineura invasion in cancer of the larynx

PURPOSE Perineural and vascular invasion are generally recognized as poor prognostic factors in cancer. The authors report the prognostic significance of perineural and vascular invasion in cancer of the larynx. MATERIALS AND METHODS The laryngectomy specimens of 94 patients with squamous cell carcinoma of the larynx were analyzed histopathologically for vascular and perineural invasion. Prognostic significance of vascular and perineural invasion was evaluated related to the cervical lymph node metastasis, recurrence, and disease-free survival. RESULTS Vascular invasion significantly influences cervical lymph node metastasis for supraglottic tumors, yet not for glottic and transglottic tumors. Perineural invasion has marginal significance in cases of cervical lymph node metastasis of supraglottic tumors; it has no significance in cases of cervical lymph node metastasis of glottic and transglottic tumors. Vascular invasion significantly increases local and regional recurrence rate, but not distant metastasis rate. Perineural invasion significantly increases local recurrence rate, but not regional recurrence and distant metastasis rate. The disease-free survival is significantly shortened by the presence of vascular and perineural invasion. According to multivariant analysis, neither vascular nor perineural invasion significantly effects the disease-free survival independently (P> .15). The presence of vascular invasion significantly affects the recurrence independently (P=.045). The presence of vascular invasion significantly reduces the interval between surgery and the development of recurrence (P=.013). CONCLUSION The presence of vascular and perineural invasion should be checked in every laryngectomy specimen because both have a significant prognostic value; both influence the disease-free survival and recurrence significantly. Vascular invasion significantly increase cervical lymph node metastasis of supraglottic tumors; perineural invasion has only marginally significant effect on cervical lymph node metastasis of supraglottic cancers. Vascular invasion plays an independent role in determining the recurrence.

HELICOBACTER PYLORI: A POSSIBLE ASSOCIATION WITH OTITIS MEDIA WITH EFFUSION

OBJECTIVE: Evaluate possible role of Helicobacter Pylori in pathogenesis of otitis media with effusion (OME). STUDY DESIGN AND SETTING: Randomized controlled trial, tertiary referral center. STUDY GROUP: Middle ear fluid was aspirated, a biopsy was taken from the promontorium of 22 children with OME. CONTROL GROUP: A small biopsy was taken from the promontorium of 20 children with normal otologic findings. For both groups, 5 mm deep tissue specimens were obtained from tonsil and adenoid. RESULTS: H pylori presence in the middle ear, the tonsillar and adenoid tissues by culture and PCR was significantly more frequent in the study group compared to the control group (P < 0.05). CONCLUSIONS: This study is the first to grow H pylori in middle ear in OME. Significantly increased colonization by H pylori of the middle ear, and tonsillar and adenoid tissue in patients with OME indicates that the bacteria might be involved in the pathogenesis of OME. EBM rating: A-1b

Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip.

Tumor thickness is a relatively new prognostic factor that has been investigated for lower lip cancer. This study was performed in 27 patients, 13 of whom had histopathologically confirmed cervical metastasis, to investigate whether tumor thickness could be used as a predictor of cervical lymph node metastasis. The mean tumor thickness of those cases with neck metastasis was 5.60 mm (SD = 2.24), and the mean thickness of cases without neck metastasis was 3.79 mm (SD = 1.68). The difference between tumor thicknesses of both groups was found to be statistically significant (P < 0.05). The tumor thickness of 5 mm was determined as a cutoff point, above which the cervical lymph node metastasis rate was significantly increased. As a conclusion, tumor thickness is an objective histopathologic factor that is easily reproducible; it significantly influences cervical lymph node metastasis in lower lip cancer, and it may be used in the assessment of prognosis. (Otolaryngol Head Neck Surg 2000;122:139–42.)

Treatment of oroantral fistula:experience with 27 cases

PURPOSE To review patients with chronic oroantral and oronasal fistula who underwent surgical correction. MATERIAL AND METHODS Twenty-seven patients with chronic oroantral and oral fistula who underwent surgical correction in the Hacettepe University Faculty of Medicine Department of Otorhinolaryngology Head and Neck Surgery between 1968 and 2001 were reviewed retrospectively. RESULTS Local mucosal flaps were used for surgical correction. The underlying factors were tooth extraction in 13 patients (48%), tumor in 5 (18.5%), osteomyelitis in 3 (11%), Caldwell-Luc procedure in 2 (7.5%), trauma in 2 (7.5%), dentiginous cyst in 1(3.7%), and correction of septal perforation in 1 (3.7%). Among the fistulas, 23 were oroantral, 3 were oroantronasal, and 1 was oronasal, respectively. Two patients required revisional repairment. The surgical procedure failed in 1 diabetic patient and 3 patients with prior history of external radiotherapy. CONCLUSION Tooth extraction was the most common etiologic factor, and malignancy should be excluded in all patients. The outcome may not be satisfactory in patients with systemic disease and in patients with history of radiotherapy. Multiple surgical interventions may be necessary only on rare occasions.

Prognostic significance of histopathological parameters in cancer of the larynx

Abstract In this study we investigated the prognostic significance of differentiation, the mode of tumor invasion to surrounding tissues, the microscopic appearance of tumor, peritumoral lymphocytic infiltration and cartilage involvement according to disease-free survival, and the recurrence and presence of cervical lymph node metastasis in cancer of the larynx. Only the mode of tumor invasion to surrounding tissues was significantly related to survival (P < 0.05). The patients with “well-defined margin” tumors survive significantly longer than those with “groups of cells, no distinct margin.” Patients with supraglottic tumors and a mode of invasion other than “well-defined margin” have a significantly higher risk of recurrence (P < 0.05) and therefore require adjuvant therapy. Patients with poorly differentiated, cartilage invading, ulcerative supraglottic tumors, and patients with glottic tumors having diffusely infiltrating margins, certainly need elective neck dissection (P < 0.05). According to the multivariant analysis, none of the factors significantly affect disease-free survival independently (P > 0.15). According to multiple logistic regression and cox regression analysis, in decreasing order of significance, the mode of invasion, microscopic tumor appearance and lymphocytic infiltration significantly affect the recurrence and time between surgery and the development of recurrence independently (P < 0.15).

Utility of anti‐HSP 70, TNF‐α, ESR, antinuclear antibody, and antiphospholipid antibodies in the diagnosis and treatment of sudden sensorineural hearing loss

To investigate the performance of various laboratory tests used for patients with sudden sensorineural hearing loss (SSNHL).

The role of oxidants and antioxidants in otitis media with effusion in children.

OBJECTIVE: Determine the possible role of oxidants and antioxidants in the pathogenesis of otitis media with effusion in children. STUDY DESIGN AND SETTING: Randomized controlled trial, tertiary referral center. The study group was made up of children with otitis media with effusion who were to undergo bilateral ventilation tube insertion and adenoidectomy. The control group was comprised of otherwise healthy children. The blood levels of antioxidants (retinol, β-carotene, (α-tocopherol, laycopene, ascorbic acid, superoxide dismutase, glutathione peroxidase, GSH) and oxidation products (malondialdehyde) were determined before and 1 month after the operation in the study group and once only in the control group. These substances were also measured in the adenoid tissue and middle ear fluids. RESULTS: In the study group, the blood levels of antioxidants and oxidants before and after the operation were significantly different when compared with the control group (P < 0.05). In the study group, the blood antioxidant levels increased and oxidant levels decreased significantly after the operation (P < 0.05). The levels after the operation never reached those of the control group. CONCLUSIONS AND SIGNIFICANCE: Oxidants and antioxidants played a significant role in the pathogenesis of otitis media with effusion in children. These children are under significant oxidative stress. Insertion of a ventilation tube and adenoidectomy significantly decreased the oxidative stress in these patients, but could not normalize it completely. Additional studies are necessary in the clinical use of antioxidants in otitis media with effusion.

The effect on arterial blood gases and heart rate of bilateral nasal packing

In order to elucidate the blood gas and heart rate changes caused by bilateral nasal packing, 21 healthy subjects who had had septoplasty or septorhinoplasty were investigated with pre- and post-operative blood gas measurements and 24-h Holter monitoring. Nasal packing caused a significant decrease in O2 saturation (P < 0.05), a borderline decrease in PO2 (P = 0.09), insignificant changes in PCO2, pH and HCO3 (P > 0.05), a significant increase in minimum and mean heart rates (P < 0.05) and insignificant changes in maximum heart rates; however, further research is necessary to elucidate the direct cause-and-effect relationship. No serious arrhythmias were observed. Although these changes may be within normal levels for healthy subjects, they may have serious consequences for patients with cardiopulmonary diseases.

Mucopolysaccharidosis: Otolaryngologic findings, obstructive sleep apnea and accumulation of glucosaminoglycans in lymphatic tissue of the upper airway

OBJECTIVE The aim of this study is to evaluate otolaryngologic problems (upper airway obstruction, obstructive sleep apnea, restriction of mouth opening, middle ear effusion, hearing and breathing problems) and their treatments on mucopolysaccharidoses (MPS) patients and to investigate accumulation of glucosaminoglycans (GAG) in the upper airway biochemically and pathologically. METHODS 76 MPS patients were evaluated. Forty-two MPS patients underwent polysomnography (PSG) for obstructive sleep apnea (OSA). Pre- and postoperative PSG results of 18 patients were compared. The success and complications of treatments for OSA in MPS were evaluated. Biochemical and histopathological accumulation of GAG in tonsil and adenoid tissue and middle ear effusion were analyzed and compared with the control group. RESULTS Forty patients out of 42 tested with PSG had OSA (95%). Adenoid grade, Mallampati grade, restricted mouth opening, rate of difficult intubation were significantly different among MPS subtypes. MPS types III and IV had significantly lower Mallampati scores; type VI had significantly worse mouth opening; and type III had significantly better mouth opening and higher rate of easy intubation when compared to other MPS types. There was no significant difference between MPS subtypes according to tonsil grade, adenoid grade, rate of otitis media with effusion and OSA severity. Statistically significant difference was found between GAG accumulation in adenoid tissue and middle ear effusion of MPS and control group (p<0.05). However, GAG accumulation in tonsil was not significantly different between MPS and control group. There was a statistically significant improvement in postop Apnea-Hypopnea Index (AHI) compared to preop AHI (p<0.05). CONCLUSIONS Most MPS patients have airway obstruction and OSA due to adenotonsillar hypertrophy. Most of these children benefit from adenotonsillectomy, after which OSA significantly improves. They experience high recurrence rate after adenoidectomy; though this is not clinically problematic. They also suffer from conductive hearing loss due to OME, which has to be treated with ventilation tube insertion. However, such operations are usually complicated by difficult endotracheal intubation and restricted mouth opening. Sometimes tracheotomy may be necessary. Tracheotomy is also highly complicated in MPS patients. Significant accumulation of GAG in middle ear fluid and adenoid tissue is present; however, GAG appears not to accumulate in tonsillar tissue.