The effect of primary thyroid surgery on the morbidity of reoperative thyroid surgery.

OBJECTIVES: This study aims to investigate the effect of primary surgery on the morbidity of reoperative thyroid surgery. PATIENTS AND METHODS: Fifty-seven patients (14 male, 43 female; mean age 41 years; range 21 to 70 years), who underwent reoperative thyroid surgery in our clinic between January 2007 and January 2012 were retrospectively analyzed in terms of vocal cord paralysis, temporary or permanent hypoparathyroidism, and other complications. The patients were classified into two groups. The first group consisted of 42 completion thyroidectomy patients that had undergone the primary operation of unilateral total lobectomy + isthmusectomy in our clinic, whereas the second group consisted of 15 patients that had undergone bilateral subtotal or near total thyroidectomy in another center. Complication rates were compared between the groups. RESULTS: Complication rates were observed as permanent vocal cord paralysis in one patient (1.7%), permanent hypocalcemia in two patients (3.5%) and temporary hypocalcemia in four patients (7%). None of the patients had temporary vocal cord paralysis. The complications in the second group were significantly higher than the first group (p=0.021). CONCLUSION: The minimal operation should be hemithyroidectomy (total lobectomy and isthmusectomy) to minimize the complications. This approach removes the need for the intervention to the previous surgery field during reoperative thyroid surgery.

The effect of intraperitoneal administration of zinc aspartate on myringosclerosis in perforated tympanic membranes of rats.

OBJECTIVES: The objective of the present study was to determine the effect of zinc aspartate on myringosclerosis in perforated rat tympanic membrane. PATIENTS AND METHODS: Fifteen Sprague-Dawley rats were randomly divided into three groups each containing five rats. Automicroscopic examinations were performed and then all rats were bilaterally myringotomized. Group 1 received no treatment. Group 2 was treated with intraperitoneal injection of physiological saline and group 3 with intraperitoneal injection of zinc aspartate. Tympanic bullas were harvested after 20 days. Histopathological evaluation was carried out under the light microscope. RESULTS: When the groups were compared in the light of the myringosclerotic findings, while there was no significant difference between group 1 and 2 (p=1.00), it was found that there were significant differences between group 1 and 3, and between group 2 and 3 (p<0.03). CONCLUSION: It appears that zinc aspartat treatment has beneficial effects on prevention or retardation of the development of myringosclerosis, but further studies are needed to clarify this effect.

Outcome of surgery for crooked nose: an objective method of evaluation.

OBJECTIVES: The aim of this study was to report the authors' surgical results, and to present their method of angle measurement using the Scion Image computer program to evaluate surgical results for crooked noses. METHODS: The study included 27 patients with crooked noses: classified as C-type and 14 classified as I-type. Deviation angles were measured by using the Scion Image computer program on frontal views before and at least 3 months after the operation. Correction of the crooked nose was performed through an open approach with the patients under general anesthesia. RESULTS: Significant correction was achieved for both types of crooked noses (p <0.05). The results for the I-type crooked noses were closer to the ideal angles than those for the C-type, but the difference was not significant. The findings showed that 66.7% of the patients with crooked noses, had good or excellent results after surgery: 53.8% of those with the C-Type and 78.6% of those with the I-type. CONCLUSION: It is difficult to achieve satisfactory results in the correction of crooked noses. The angle measurement method using the Scion Image computer program may be helpful in evaluating the effectiveness of different surgical techniques.

Chondrosarcoma of the sphenoid sinus resected by an endoscopic approach.

Chondrosarcoma of the sinonasal tract is a rare neoplasm. Surgical excision is usually sufficient for low-grade lesions, whereas combined treatment is usually recommended for high-grade lesions. The oncologic outcome depends on a complete resection as well as the grade of the tumor. We present the case of a 35-year-old man presenting with an incidental finding of a chondrosarcoma of the posterior septum and rostrum of the sphenoid sinus. The tumor was completely resected using a transnasal endoscopic approach obtaining negative margins. Surgery is the mainstay treatment for low-grade chondrosarcomas. In selected patients, complete resection can be achieved using transnasal endoscopic approaches.

The role of food allergy in otitis media with effusion.

OBJECTIVE: To detect the relationship between food allergy and otitis media with effusion (OME). MATERIALS AND METHODS: This study was performed on three different groups. The patient group was made up of 56 patients with OME (group I). There were 28 patients with food allergy in group II and these patients were investigated for OME. The control group consisted of 28 patients without any complaints concerning food allergy or OME (group III). RESULTS: Food allergy was detected in 25 patients with OME (44.6%) (group I). In patients with food allergy (group II), OME was detected in 7 patients (25%). In the control group (group III) food allergy was diagnosed in 5 patients (18%) and OME in 1 patient (3%). The incidence of food allergy in OME group was statistically significant when compared to the normal group (P > 0.05). CONCLUSIONS: This study demonstrates that food allergy may play a role in the etiopathogenesis of OME.

Chronic rhinosinusitis and adenoid hypertrophy in children.

PURPOSE: The purpose of this study was to investigate the relationship between adenoid microbiology, adenoid size, and maxillary sinus microbiology in children with both chronic rhinosinusitis and adenoid hypertrophy. METHODS: The children with both chronic rhinosinusitis and adenoid hypertrophy were admitted to this prospective study. The study included 30 children. The diagnosis of chronic rhinosinusitis was based on clinical and radiologic examinations. Adenoid hypertrophy was classified as medium and large based on the preoperative flexible fiberoptic endoscopy and nasal endoscopy during surgery. Maxillary sinus aspiration and adenoidectomy was performed in all patients. Sinus aspirate and adenoid tissue specimens were cultured. The correlation of culture results was investigated. The relationship between adenoid size and maxillary sinus culture results was analyzed by using chi-square test. RESULTS: Adenoid sizes were medium in 12 (40%) and large in 18 (60%) cases. Bacterial growth was found on 14 of 30 (47%) sinus aspirate, and all adenoid specimen cultures showed bacterial growth (100%). There was no statistical correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus. The relationship between adenoid size and maxillary sinus culture results was not found statistically significant (chi(2) = 0.96, P = 1.0). CONCLUSION: The reason that there was no correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus is that it seems possible that the adenoids act as a barrier causing mechanical obstruction rather than a nidus for chronic sinus infection. However, there is no relationship between adenoid size and maxillary sinus culture positivity. Medium adenoids causing partial obstruction may lead to changes in the microenvironment and may start bacterial growth in children with positive maxillary culture. Further investigation is needed to explain the association between adenoid hypertrophy and rhinosinusitis. Adenoidectomy helps to resolve the symptoms of chronic rhinosinusitis in the children with both chronic rhinosinusitis and adenoid hypertrophy.

The effectiveness of steroid treatment in nasal polyposis.

OBJECTIVE: The objectives of the management of nasal polyposis are to eliminate or reduce the size of polyps, reestablish nasal breathing, reduce symptoms of rhinitis, restore the sense of smell, and prevent the recurrence of nasal polyps. Local or systemic steroids have been used in the treatment of nasal polyps, but efficacy of combined (local and systemic) steroids in nasal polyposis has been little investigated. The aim of this study was to evaluate the influence of combined steroid therapy on the symptoms and extent of the disease in patients with nasal polyposis. METHODS: Seventeen patients with nasal polyps were treated with combined steroids. Before and after the therapy, polyp size, nasal symptoms, sense of smell, and headache or facial pain were assessed by an established scoring system. RESULTS: After the therapy, symptom scores of all the patients improved. Of the patients, 12% showed a polyp-free nasal cavity, 76% a clear involution of polyps, and 12% no response to the therapy. There were statistically significant differences (P<0.001) for symptom scores and polyp size. Medical ablation of polyps using steroids was not achieved in 88% patients. CONCLUSION: Steroids can reduce polyp sizes and improve the symptoms, but are inadequate to eradicate the polyps. Surgery still plays a major part in the treatment of the nasal polyposis, but steroids can delay the necessity for surgical intervention.

Autoimmunity in the etiology of otitis media with effusion.

Otitis media with effusion (OME) is one of the most common health problems seen in children. The role of autoimmunity in the etiology of OME has been discussed for a long time. The purpose of this investigation is to determine the role of circulating antibodies in the pathogenesis of OME. The presence of antibodies against rabbit tympanic bulla epithelium was investigated by indirect immunoflouresence in the serum samples of 25 patients with OME and serum samples of 25 healthy children as a control group. In the control group, positive staining was seen in only 1 case (4%), whereas 8 cases with OME were positively stained (%32). There was statistically significant difference between the 2 groups. The presence of antibodies against middle ear epithelium in the cases with OME suggest that autoimmunity might play a role in the formation of effusion in the tympanic cavity.