The effect of preoperative neutrophil, platelet and lymphocyte counts on local recurrence and survival in early-stage tongue cancer.

The aim of this study was to investigate the predictive value of preoperative neutrophil, platelet and lymphocyte counts in local recurrence and survival in the patients operated for early-stage squamous cell carcinoma (SCC) of the tongue. 57 patients who underwent surgery for early-stage (stage 1-2) SCC of the tongue were enrolled in the study. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and neutrophil × PLR value (N × PLR) were used as outcome measures. Local recurrence was detected in 11 (19.3 %) patients during follow-up period. Mortality was seen in 7 (12.3 %) patients. 37 (64.9 %) patients had stage 1 and 20 (35.1 %) patients had stage 2 tumor. NLR, PLR and N × PLR cutoff values were determined as 2.26, 146,855 and 689,912, respectively, by receiver operating characteristic analysis. The relationship between NLR, PLR, N × PLR and local recurrence was statistically significant according to these cutoff values (p values 0.021, 0.020, 0.017, respectively). We suggest that NLR, PLR and N × PLR may be used to predict local recurrence, while their use in overall and disease-free survival is limited. Further studies involving large patient groups are required.

The effect of antireflux surgery on laryngeal symptoms, findings and voice parameters.

The aim of this study was to evaluate the effect of laparoscopic antireflux surgery (LARS) on the laryngeal symptoms, physical findings and voice parameters of gastroesophageal reflux disease (GERD) patients with or without laryngopharyngeal reflux (LPR). Forty-one GERD patients predominantly with LPR symptoms (Group I) and twenty-six GERD patients without LPR symptoms (Group II) who had LARS were prospectively analysed before and 2 years after the surgery. Upper gastrointestinal endoscopy, 24-h ambulatory pH or MII-pH monitoring was performed in all cases. A reflux study group including specialists from five departments in a university hospital decided surgical indications. Patients were asked to fill out a validated LPR and voice quality questionnaire (Reflux Symptom Index and Voice Handicap Index-10). Laryngeal findings were evaluated and scored using a laryngoscopic grading scale [Reflux Finding Score (RFS)], by four blinded ENT specialists. GRBAS scale was done by a blinded otolaryngologist. Voice parameters were measured objectively via the Multi Dimensional Voice Programme (MDVP). The mean age was 45.8 ± 8.5 for Group I (24 men) and 48.9 ± 12.3 for Group II (16 men). The mean follow-up after LARS was 24.5 ± 1.3 months for Group I and 25.2 ± 1.1 months for Group II. The preoperative mean score of RSI was 22.8 ± 7.4 vs. 11.2 ± 6.6; RFS was 10.6 ± 2.3 vs. 5.7 ± 2.5 and VHI was 18.07 ± 4.4 vs. 10.86 ± 3.3 for Group I and II, respectively. The postoperative mean score of RSI was 12.9 ± 6.4 vs. 8.4 ± 4.5; RFS was 6.9 ± 2.0 vs. 4.5 ± 2.3 and VHI was 9.59 ± 4.4 vs. 7.95 ± 3.5 for Group I and II, respectively. Group I had significantly lower RSI and RFS scores following LARS compared to the preoperative scores. LARS successfully improved RFS, RSI and VHI in carefully selected patients with GERD, especially the signs and symptoms related to the larynx and voice. Although the indications for LARS are limited in patients with LPR symptoms, these results favor the decision-making period of LARS.

[Middle ear ossicular replacement prostheses: cause of failure]. / Prothèses ossiculaires d'oreille moyenne: causes d'échec.

There are various prostheses used for ossiculoplasty in chronic middle ear disease. Plastipores are one of the most commonly used prostheses. We performed ossiculoplasty with plastipores in 237 ear operations in a five years period. The results of the operations were summarized and causes of prosthesis failure were discussed. In 55 (23.2%) patients, tympanic membrane perforation recurred. Cholesteatoma recurrence was encountered in 16 (6.8%) cases. The extrusion of prosthesis was observed in 10 (4.2%) cases. The underlying ear disease was cleaned in 156 (65.8%) patients. An air-bone gap to within 20 dB was achieved in 87 (55.8%) ou of 156 patients. In 69 (44.2%) the gap closure was more than 20 dB. The experience of the surgeon in otologic surgery, severity of the chronic ear disease, status of the eustachian tube, extention of the ossicular chain disruption, type of surgery and characteristics of the prosthesis are critical for ossiculoplasty.

Radiographic evaluation of children with nasopharyngeal obstruction due to the adenoid.

The adenoidal-nasopharyngeal ratio (ANR) was proposed as a convenient and practical method to evaluate adenoidal enlargement. We analyzed cephalometric radiographs of 150 children divided into 6 subgroups according to clinical assessment (possible adenoidectomy candidates [PACs] and controls) and age. Our purpose was to investigate the predictive reliability of different ANRs calculated on the same reference line. Each of the ANRs described in this study presented statistically significant differences between PACs and control groups, and highly significant correlations with clinical symptoms of nasal obstruction. Further, the mean adenoidal depth was significantly larger in PACs than in normals, and it was found that the adenoidal depth in PACs did not show a significant decrement with age. in contrast to normals. On the other hand, although nasopharyngeal depth was not different between PACs and normals, an age-dependent increment was observed in PACs, in contrast to normals. Thus, it could be said that the ANR is a more reliable method for determining whether adenoidal hyperplasia is clinically significant or not, rather than the size of the adenoid or nasopharynx.

Clinical importance of the Korner's septum.

OBJECTIVE: To evaluate the clinical importance of the petrosquamosal lamina (Korner's septum [KS]), which is not only a bony plate dividing the mastoid cells at the level of antrum, but is also a lamina starting from the posterior aspect of the glenoid fossa that extends above the middle ear cavity and courses in an inferior direction lateral to the facial canal and proceeds to the mastoid apex. STUDY DESIGN AND SETTING: A retrospective review of 688 mastoidectomies performed in University Hospital from 1987 to 1992. PATIENTS: The study group consisted of 389 males and 299 females (mean age 30.85 +/- 12.80, the youngest being 8 and the oldest being 67 years of age). MAIN OUTCOME MEASURES: The main outcome measures were the prevalence of KS encountered during mastoidectomies and comparison of prevalence of retraction pockets (RPs) or retraction and/or adhesion of the whole tympanic membrane (R/A-TM) between ears with KS and without KS. RESULTS: The prevalence of KS was 30.4% among the ears with RP or R/A-TM, 6.58% in normal ears, and 17.4% in ears with chronic otitis media without RP or R/A-TM. CONCLUSIONS: KS is an important anatomic handicap predisposing the individual to chronic otitis media, particularly when it is characterized by attic retraction pockets and cholesteatoma, and adhesive otitis media, because KS contributes to attic blockage. This statement is in accordance with the original articles written by Cheatle (1910, 1923) and Williams (1966), and recently published data related to supratubal recess and the cog (Tono et al., 1996).

Experimental otitis media induced by coagulase negative staphylococcus and its L-forms.

In a previous study, we found 15% L-forms of bacteria (predominately coagulase negative staphylococci (CNS)) in ears which gave negative cultures by conventional methods. In this study, we used an animal model to test whether CNS and its L-forms can be pathogenic and whether L-forms have a crucial role in the tendency to secretory otitis media (SOM). We inoculated the tympanic bullas of guinea pigs, in 2 groups, with CNS and its L-forms (revertant forms). We observed that both CNS and its L-forms had the capability of causing infection. However, it was milder for the L-forms than CNS. We clearly noticed that on day 30 60% of the ears inoculated with L-forms had effusion and/or retraction of the tympanic membrane. These ears were histopathologically characterized by hypertrophied pseudostratified epithelium or stratified squamous epithelial metaplasia. The ears inoculated with the original form of CNS had only 16.66% effusion. On day 60 we observed similar findings. Thus, it might be proposed that L-forms could be responsible for chronic irritation to middle ear mucosa leading to SOM.

Otitis media with effusion and craniofacial analysis-II: "Mastoid-middle ear-eustachian tube system" in children with secretory otitis media.

Secretory otitis media (SOM) is a disease of childhood, and this period is characterized by active growing of the craniofacial skeleton (CFS). In this study, we purposed to answer the question 'how deviations in CFS play a role in ethiopathogenesis of SOM'? Therefore, we evaluated the 'mastoid-middle ear-Eustachian tube (M-ME-ET) system' in 30 SOM cases and 30 healthy children by using lateral cephalographies on which reference points and one line related to CFS and 'M-ME-ET system' were pointed. The results disclosed that the bony Eustachian tube, the vertical portion of the tensor veli palatini (TVP) muscle and the mastoid air cell system were smaller in SOM cases. In the view of the statements of Enlow (1990) on craniofacial growth, we suggest that the deviations in the growth process of the nasomaxillary complex lead to corresponding imbalances in the bony tube and vertical portion of the TVP. However, since regional imbalances often tend to compensate for one another to provide functional equilibrium (Enlow, 1990), improvement of the tubal function occurs with age.

The role of retraction pockets in cholesteatoma development: an ultrastructural study.

Persistent retraction pockets causes erosion by adhering to ossicles and other structures of the middle ear. These are characterized by lysis of fibrous layer. Being in contact the squamous epithelium and the middle ear mucosa, it comprises the precursor mechanism of cholesteatoma. The present study discards the classical theories assuming epithelial migration through marginal or attic perforation; and demonstrates that these secondarily develop as a result of cholesteatoma. Retraction pocket specimens obtained from 10 cases of adhesive otitis media were examined with light and transmission electron microscopy and the presence of papillary ingrowth of the squamous epithelium was demonstrated.

Anatomy of the guinea pig temporal bone.

The middle ear of guinea pigs has long been used for experimental studies, but no detailed information about its temporal bone anatomy is available. In 18 adult guinea pigs, the temporal bone, eustachian tube, and inner ear anatomy, in addition to the anatomy of the middle ear, were investigated under the dissection microscope. In addition to properties of the eardrum, ossicles, air cell system, and cochlea previously described, the appearance of Huschke's foramen and the crista stapedis in an adult guinea pig ear, the structure of the eustachian tube, the architecture of the internal auditory canal, and the communication of the mastoid cells with the tympanic bulla are described. Differences and similarities among guinea pigs, other experimental animals, and humans are discussed to show the advantages and disadvantages of the guinea pig ear for experimentation.

[Surgery of the endolymphatic sac and preservation of hearing in endolymphatic hydrops]. / La chirurgie du sac et la conservation du niveau de l'audition dans l'hydrops endolymphatique.

Vertigo is the most important symptom of Ménière's disease both from the standpoint of follow-up and indication for surgery. But although vertigo is an alerting symptom for both the patient and the physician, we believe that the hearing level is the most reliable and even the single sign in determining the recent status of the disease. Between 1983-1989, 42 patients with various types of Ménière's disease (MD) (34 typical MD, 3 cochlear MD and 3 vestibular MD) underwent endolymphatic sac surgery at ENT department of Gazi University School of Medicine. In the typical MD group, patients with a duration of symptoms of less than one year prior to surgery revealed better postoperative results; 91% fell into class A and B, whereas this rate was found to be lower (40%) in patients with symptomatology lasting for more than one year. In conclusion, especially in bilateral cases, given the importance of the hearing, early sac surgery is thoroughly recommended for the conservation of hearing.