Yahya Guldiken

Evaluation of the Effect of Passive Smoking on Otitis Media in Children by an Objective Method: Urinary Cotinine Analysis

Objectives We aimed to determine objectively the effect of the passive smoking on otitis media with effusion (OME) and recurrent otitis media (ROM) by using the method of cotinine urinalysis.

Transcutaneous Bone-anchored Hearing Aids Versus Percutaneous Ones: Multicenter Comparative Clinical Study.

Objective The aim of this study is to compare the clinical audiological outcomes as well as patient satisfaction of bone-anchored, hearing aid surgery between the percutaneous Dermalock and the transcutaneous Attract systems. Study Design and Methods This is a multicenter, retrospective clinical study. The patients who underwent Baha Dermalock and Baha Attract surgery were analyzed for hearing results, surgical complications, and postoperative follow-up specifications for both systems. Speech reception thresholds and bone conduction thresholds with and without aided conditions were evaluated. Patient satisfactions were also determined for both groups by Glasgow Benefit Inventory questionnaire. Results Both of the groups had some minor complications such as skin irritations around the abutment and skin erythema over the magnet. Both of the groups benefit from the devices audiologically; however, when the groups were compared, better results were observed in the percutaneous, bone-conduction group. Conclusion We can confirm that both transcutaneous and percutaneous techniques are effective in the rehabilitation of conductive hearing loss when conventional hearing aids cannot be used. However, both of the systems have some advantages and limitations in terms of audiological and surgical perspectives.

Spinal accessory nerve function after neck dissections.

The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month. All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group. In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.

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.

Plexiform neurofibroma of the larynx in a child

A case of a female child of six years of age with a plexiform neurofibroma of the larynx caused by von Recklinghausens disease is presented. Laryngeal involvement in neurofibromatosis type 1 (NF1) is rare and only 19 paediatric cases have been reported. The tumour was biopsied and lateral pharyngotomy with supraglottic hemilaryngectomy was performed in order to relieve obstructive symptoms. Problems related to this unusual tumour localization are discussed and a review of the literature is presented.

Autologous fascia lata graft for contour restoration and camouflage in tertiary rhinoplasty.

Abstract Tertiary rhinoplasty is a surgical procedure to correct nasal deformities that have been developed after prior unsuccessful surgeries. Such surgery requires complicated manipulations and tissue grafting for proper restoration. In the current study, we report the use of fascia lata graft combined with cartilage grafts for contour restoring and camouflage. Twenty-three patients who had severe nasal deformities were included, of whom 14 were men and 9 were women. Their ages ranged between 24 and 34 years (mean, 29 y). All patients were twice previously operated on by surgeons other than the authors. An informed consent was obtained from all patients. After harvesting the costal cartilage, the fascia lata graft (mean size, 2–3 cm) was uniformly harvested from the right lateral thigh. Application of the fascia lata and the cartilage graft was achieved through the open rhinoplasty incision. The fascia lata was applied over the cartilage in the dorsal region in 20 patients (86.9%), applied over the reconstructed alar and dome area in the nasal tip in 8 patients (34.7%), and applied over both areas simultaneously in 4 patients (17.3%). Postoperative follow-up was between 14 and 35 months (mean, 24.5 mo); clinical evaluation, photographic documentation, and a questionnaire form related to donor-site morbidity and patient satisfaction were applied after 12 months of the follow-up period. Results showed that all patients had an improved aesthetic result, and no apparent irregularities were observed in the integument of the aesthetic lines. No complications or no requirement for revision surgery was observed later on. In conclusion, refinements of the nasal dorsum and the nasal tip in tertiary rhinoplasty are indeed important and difficult to be managed. Placing the fascia lata over the applied cartilage grafts provide a good cover that conceals the possible irregularities or distortions that may appear in the late postoperative period.

Follicular dendritic cell sarcoma of the nasopharynx

Follicular dendritic cell (FDC) sarcomas of the nasopharynx are rare tumours; only seven cases have been reported in the English language medical literature. The authors present an eighth case, which occurred in a 70-year-old woman whose main complaint was nasal obstruction. It has been more than 10 years since FDC sarcoma was reported to occur in extranodal sites, and clinical and pathological characteristics of extranodal FDC sarcomas remain to be defined. The lack of a high index of suspicion is the main reason for misdiagnosis. The authors point out the difficulties in the diagnosis and management of this rare condition.

Evaluation of factors concerning the patency of the internal jugular vein after functional neck dissection

Abstract. The aim of this study was to evaluate the effects of several factors on the patency of the internal jugular vein (IJV) after functional neck dissection (FND). A prospective clinical study was undertaken in 21 patients (36 neck dissections) before and after FND at the 1st and 3rd postoperative months by using duplex Doppler ultrasonography. The patients who had radiation therapy (RT) were evaluated again in the 6th postoperative month in order to assess possible late effects of radiation therapy. In our patients the patency rate was 100%, and no thrombosis was found. But the area at rest and during Valsalvas maneuver was reduced, and this difference was found to be statistically significant. It was concluded that the patency of the IJV remains normal after FND. Radiation therapy, infection or fistula formation have no detrimental effects on patency. In addition, the number of ligated branches do not seem to be related to the patency rate.

Spontaneous bone bed formation in cochlear implantation using the subperiosteal pocket technique.

Objective To show evidence of spontaneous bone pocket formation using the subperiosteal pocket technique for cochlear implantation surgery. Study Design Clinical capsule report. Setting University hospital. Patients We evaluated 8 pediatric revision cochlear implant patients who had previously undergone cochlear implantation using the subperiosteal pocket technique. The time between primary and revision surgery varied between 5 and 54 months. Results Spontaneous bone bed formation for the internal receiver stimulator and its electrodes was observed during revision surgeries in all patients. Conclusion The subperiosteal pocket technique for cochlear implantation does not require pockets to be drilled in the skull, unlike the standard technique, because bone beds form spontaneously.

Surgical and audiological evaluation of the Baha BA400

OBJECTIVE Despite extensive soft tissue reduction, the most common complications associated with bone-anchored hearing aid systems, also known as bone-anchored hearing implants, are related to adverse skin reactions around the abutment. The necessary soft tissue reduction also adds complexity to the surgical procedure. This study aimed to evaluate the surgical and audiological outcomes of a new connective interface of the Cochlear™ Baha® BA400 device implanted using the one-stage surgical technique. METHOD A multicentre, retrospective case series is presented, including data collected from three tertiary care institutions. RESULTS In total, 16 patients who had undergone bone-anchored hearing aid surgery over a 10- to 12-month period were assessed for hearing performance, implant stability and surgical complications. CONCLUSION This case series indicates that new abutments with a hydroxyapatite coating can be implanted percutaneously without soft tissue reduction. Furthermore, device implantation using this surgical technique may have some advantages compared with a conventional device and procedure combination over 12- to 16-months of follow up.